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TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator <br />I.Name ol Event:1. <br />2 <br />Address; <br />Phone: <br />3 <br />4 <br />0 0 <br />5< <br />Approved water for drinking, utensil and hand washing will oe provided in my bootn by the fbi|owmg methods:6. <br /> Approved tx>ttted water <br />7. <br />8 <br />9 <br />meats, females, cooked beans, rice. <br />TEMP’EVENTS <br /> Camp stove <br /> Double steamer <br /> Elec* ic stove top <br /> Stemo & hotel bays <br />Q Steam table i lids <br />® Other (specify) <br />Note: Examples of potential y hazardous food include* <br />vegetables, potato salad, eggs, and dauy products. <br />Oate($): <br />EHO <br />1 fo^TdX^^ awhot and 01 <br />I am providing the fallowhg hoi temperature control for the hot holding of ail potenifelfy h bayous tbods above <br />J 50 * - <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispense is, or prepackaged foods from approved sources. <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, simiar material and fine mesh fly <br />screening, completely enclosing open food areas it will also have a smooth and deanable floor (concrete <br />asphali. dean tarps and smooth wood are acceptable) and consbucted to separate food and food preparation <br />areas ftom ttie pubic. <br />B Other (spectfy): |A <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checkl’st to <br />3) weehs prior to this event. <br />Weberstown Farmers Market <br />---------------T------------------------—------------------ <br />The following is information about my organiMttorVtasinees <br />Name of oigamzabon/business: ^KQiaJl <br />tA. gn; Cft ------------- <br />( Alternate: ( )---------------------------------------- <br /> List food to be sold or given to thepublia cCfc yrnrrtk k rc ftp | CK\) kS <br />I am providing food that is NOT prepared at home; 0 Yes No <br />All food is prepared qn-site or is from approved commercial facilities [3 Yes No <br /> N.^oriMM, Ka ______n___pworHili -STH- S33____ <br />I am providing a booth with the following: (toprotect my unpackaged food and food-pieparabon areas fiom flies, <br />dust and the public) <br />O On-site hose bib that is connected tea poteble water source <br />S Other (speafy): Ja <br />Electricity is provided for my booths use: Q Yes KJ No