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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event:1.Date(s): <br />The following is information about my organization/business:2. <br />AU C-r LI CName of organization/business: <br />I Address: <br />Phone:( KJ --£.1S4 <br />3. <br />4. <br />5. <br />EUther (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />0 Other (specify): <br />Electricity is provided for my booth's use: Yes 0 No7. <br />8. <br />9. <br />T-_MP( .izN’. AFPPage 7 of 11EHD 16-02 <br />08/01/16 <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Ia/ rx <br /> On-site hose bib that is connected to a potable water source. <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes Q No <br />Name of facility: h th K \ hz-hen Phone: (A 1^. ) 3> 8^ <br />Address of facility: ,2 11 IaZ rx y Ao 4________________ ___ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Saturdays <br />Market on Maple May-Oct <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />t / <br />a ck<M ‘MY____ <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. <br />meats, tamales, cooked ben 'ice, <br />7~ A r C-k y <br />C ¥?»■*(■'h A? . C A .< ?? 2-^ <br />Alternate: (^ I o ) I Q - U <br />hlf-L C iiZ|xS {O A Vc"