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DatefsJ1. <br />2 <br />Address <br />Pho«»e <br />3 <br />4 <br />S <br />Cj i/t./C • <br />8 Approved waler foe dnnkmg. utensil and hand washing wilt be provided in my booth by the following methods <br /> Approved bottled water. <br /> On 4 ite hose M> that is connected to a poiabie water source. <br />7 <br />8 <br />8 <br />135T <br />meats, tamales, cooked beans, rice, <br />Mae Torn T6MP EVENT «ep <br />EWtsoe oeroi/ia <br /> Stemo (.hotel trays <br />D Steam table & lids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br /> Etecbfc stove top <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fl'es^. <br />dust and die public) <br />0 A booth with wale and eeiiing constructed of either wood, canvas, plastic, similar matertai and tine mesh fly <br />screenng. completely enclosing open food areas, ft wiiralso have a smoeth and cleanable (toor (concrete, <br />asphalt dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />JS^Obier (specify) All /-rDS Z0 <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 />temporary food vendor s application <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of thfs cnecktst to <br />Sundays <br />Year Round <br /> Other (spec'fy) ____________ <br />Electricity rs provided for my booth's use Yes ^Sfwo <br />I am providing an accurate probe thermometer lo mysure the hot and cold hold ng of potent ally hazardous <br />foods during all times of booth operation: O Yes £§^0 <br />I am providing the following hot temperature control for the hot hotting of all potenliaVy hazardous foods above 135F JlPr <br />the festival coordinator three (3) weeks prior to this event <br />. • Weberstown Farmers Market 1 Nameof Event , .. ----------------- <br />The fotowng is information about my organization/business: <br />Name of organ izakonfousmess’ <br /> <br /> Alternate: --------- <br />tst foodie be sold orgiven to theotibhc X -------------- ------------------------------------- <br />I am providing food that is NOT prepared at home £j^res No <br />AM food 6 prepared o n-s te or 6 from approved commercial facilfies: ^Yes No <br />Name of facility A s Rhone (IdTl --------— <br />Addressoffacility t Av€-____________________________________- <br />Note: Exampfos of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.