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f TEMPORARY FOOD VENDOR'S APPLICATION I All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to i the festival coordinator three (3) weeks prior to this event. Weberstown Farmers Market Sundays Year Round 1. 1.Name of Event: _ - Date(s): Thursdays May-Nov 2. The following is information about my organization thus iness: Name of organization/business: _06f ins COOV—tie 00 . Address: 23215 6r42�0n a,Jt✓ Phone: ( `j,C� ) _ 11 ."� �L� Alternate: (20cj )_4W 3q I q 3. List food to be sold or given to the public: -Q 01F00d e,u1 i, Lre PM V�GkG l�VI CI ,d1 (Ypc��, uhn�nt YO i! 4. 1 am providing food that is NOT prepared at home: ❑Yes ® No All food is prepared on-site or is from approved commercial facilities: ❑ Yes® No Name of fa61ity: _Q3AtCW_ %,me '60l0,"N Phone: `i q S- 3q Address of facility: "' 2325 6 n 4A• S;tY_%L trn 20 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas, It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ® Other (specify): Q11 d lS ire ayCk4Su� Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. ❑ On site hose bib that is connected to a potable water source. ® Other(specify): ^5 CP\t QM hla8'X 1A5 wVk-(, k' &fZ Gj !d WCk-QA 7. Electricity is provided for my booth's use: ❑ Yes X No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 4 Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑ Camp stove ❑ Stemo&hotel trays ❑ Double steamer ❑Steam table&lids ❑ Electric stove top Z]Other(specify) J)o heCti 1S nuAkJ. Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. EHO:6-02 Page 7 0l7I TEMPEVE,NTAPP 08f01ri 5