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TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Sundays 1. 1.Name of Event: Weberstown Farmers Market Year Round 2. The following is information about my organization/business: �! Name of organization/business: -M S C7 LE C,_,,,,,,,,,, L AA I lrcysLL me Address: 2 Phone: { g } Alternate: (3lo Lf -- 4 3. List food to be sold or given to the public:.yam t ZVeA cLm Z )he 4. I 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 facility: -;rA0 fns�J`(' k,'fri+'►; Phone: g— Address of facility: c 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. [QrOther(specify):_�� A a i�g _�C q c�Ca _ _ .1 rj ,Si ao ce.6 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): 7. Electricity is provided for my booth's use: ❑ Yes® 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: ® 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 ❑ Sterno& hotel trays ❑ Double steamer ❑ Steam table& lids ❑ Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cno:ced bc^. Z. -ice, vegetables, potato salad, eggs, and dairy products. EH7 16.02 Page 7 of 11 1) OEV01116