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Date(s).1. <br />2 <br />‘V <br />Address <br />Phone <br />3 <br />4 <br />5 <br />Qi/crC • <br />6 Approved waler for drinking, utensil and hand washing will be provided m my booth by the following methods <br /> Approved bottled water <br />QOn-site hose bib that 6 connected to a potable water source <br />7 <br />8 <br />S <br />meats, tamales, cooked beans, rice. <br />7 oi 11 T6MP EVENT AFp <br /> Camp stove <br /> Double steamer <br />O Eleckic stove top <br />1 am providing a booth wrth the fol owing (to protect my unpackaged food and food-preparation areas from fl'es, <br />dust and the public) <br />0 Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />D Other (specify) ___________________________. <br />Electricity is provided for my booth s use O Yes p^No <br />exo tec? <br />All food vendors (both for profit and non-profft) are required to return a si; <br />the festival coordinator three (3) weeks priorto this event <br />Market (Vlayile <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />igned and completed copy of this checklist to <br />Saturdays <br /> hl ay-ocT <br />I am providing food that is NOT prepared at home LJ No <br />M food ,s prepared on-site or <s from approved commercial facilities. ^Yes 0 No <br />Name of facility Phone 2? LrZ-^Zj-11 <br />Addressoffacility _ f __Z-Q---------- <br />I am providing an accurate probe thermometer to measure lhe hot and coW holding of potentially hazardous <br />foods during all times of booth operation 0 Yes <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F /T <br />Rosa's <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1 Nameof Event " <br />The (blowing is infonnation about n»y organ'zation/business. <br />Name of organizakoni'bus’ness \S1 V---------------- <br />__ Alternate ( T.6! ) <br />1st food to be sold orgwen to the public _ ___ <br />££ves No <br /> A oootii with waits and eetiing constructed of either wood canvas piastre, similar material and fine mesh fly <br />screen ng. completely enclosing open food areas It will also have a smooth and cleanable (too,- (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed Io separate food and food preparation <br />areas from the public. <br />JS^Other (specify) ?. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers or prepackaged foods from approved sources