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Date(s)1.1. Nameof Event <br />2 <br />Address <br />Phone <br />3 <br />4 <br />5 <br />Cpt/e-K • <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />O Approved bottled water. <br />□On-site hose bb that is connected to a polable water source. <br />7. <br />8 <br />meats, tamales, cooked beans, rice, <br />Ngcrolii T6MP EVENT AFP <br />eno 1602 <br /> Camp stove <br /> Double steamer <br /> Elecbic stove top <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Otfrer (specify) <br />O A booth with walls and eeiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smoeth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br /> J^Obter(specify) AVj 7^'cP h'^*' <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 />Name of organ izakonibusmess' nW <br />. Phone (Isil ^3- L±l_2±jJ--------- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />signed and completed copy of this cjieckist to <br />Sundays <br />Year Round <br />D Other (specify)___ _ _____________________ <br />Electricity is provided for my booth's use D Yes £SfNo <br />1 am providing an accurate probe thermometer to mrasure the hot and cold holding of potentially hazardous <br />foods during ail times of booth operation: Yes C3^° <br />I am providing the followh*g hot temperature control for the hot holding of ail potentially hazardous foods above <br />13ST <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Alt food vendors (both for profit and non-profit) are required to return a <br />the festival coordinator three (3) weeks priorto this event <br />Weberstown Farmers Market <br />—-------------------------- <br />The (blowing is information about my organizaton/bus'ness <br /> <br /> -------- - <br /> Alternate. ("I ) *0 <br />List food to be sold or given to thepubl’c. ____—- <br />1 am providing food that is NOT prepared at home ^yes No <br />A* frxxj s prepared on-site or is from approved commercial facilties. ^Yes No <br />Name of facility _____ <br />Address©ffacdity I <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fl'eSs <br />dust and die public)