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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2 <br />Address: <br />Ptione: <br />3. <br />4. <br />5. <br /> Other (specJy): <br />G. <br /> On-site hose bib that is connected tea poiebie water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: O Yes E'hfo7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />ParpTcr n rHMP f-Vf-NC AHF <br />Approved water for dunking, utensi and hand washing wiil be provided in my booth by the foi'-owing methods: <br />[jjApprovcd bottled water. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: The only operations not required to provide enclosed booths are those which sen beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Stomo & hotel trays <br /> Steam labie & lids <br /> Other (specify) <br />The followrig is information about my organizatiorutausiness: <br />Name of organization/bustness:, t-L lip <br />5 CC vfnht/ Pf fJraty. _____________________ <br />(5lC ) yOu 5 Alternate; (S>IO) H32 - <br />lam providing a booth with the following: (to protect my unpackagcd food and food-pcetaration areas from flies, <br />ditst and thepubfic) <br />Q^A booth with wails and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas It wil ateo have a smooth and cieanabie floor (concrete, <br />asphalt, clean tarps and smooth wood are acceplable) and constructed to separate food and food preparation <br />areas from the public. <br />List food to be said or given to the public: UlUAfWS <br />I am providing food that is NOT prepared al home: □ YesO^ta <br />All food is prepared on-site or is from approved commercial fadiiiios: Yes No <br />Name of facility:Phone: 1 1 <br />Address of facility:_____________________________ <br />Al 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 />Thurdays <br />I.Namo of Evert: ^artet on Maple QateM: May-Oct <br />CbC ie-02 <br />W.VW1C <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1 am providing the following hot temperalure control for the hot holding of all potentially hazardous foods above <br />135°F: <br />I am previding an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No