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TEMPORARY ADOD VENDOR’S APPLICATION 1.T. Name of Event:Date(s): 2. Address: Phone: 3. 4. 5. 6. 7. 8. 9. TEMP EVENT APPPs^|e?of11 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or (Repackaged foods from approved sources. Ail food is prepared Name of facility: Address of facility:. iure the hot and cold holding of potentially hazardous meats, tamales, cooked beans, rtqe. A -yr —r . 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. Weberstown Farmers Market ISO Camp stove - O Stemo & hotel trays Double steamer Q Steam table & lids Electric stove top Other (specify) Note: Examples of potentiaBy hazardous food include: vegetables, potato salad, eggs, and dairy products. The following is information about my organization/business: Name of organization/business: Q Lit Afitok (W Dr. MoA -93.56 List food to be sold or given to the pubfc: 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. D Other (specify):__________; Electricity is provided for my booth's use: O Yes [^Nlo . ’ ■ • ■ ’ ... I am providing ah accurate probe thermometer to rwasi foods during all times of booth operation: Yes [Fj No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135’F: EHD 16-02 . 08/01/16 DkWMS. FeMlt Conn__ _____________ Alternate: (^01 ) -^1 - anil QaAM fnrn I am provMrtfl food that Is NOT prepared at home: r/Yee n No , ite or is frorrl approved commercial facilities: 0Yes Q No llvS OT J fettle fgrOPhone; £__.1................ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, ■ (W and the public) A booth with wails and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation LJ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly S - screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, —i--i‘ ----------*----------- --- ------------‘----------‘---------***'‘ ‘—7— areas from the public. Other (specify):. , : ' '■ < Sundays Apr-Apr