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Date(s) .1.1. Nameof Event <br />2. <br />Name of organizatonfausmess' <br />Address <br />Phone <br />3 <br />4 <br />Ave- <br />5 <br />Approved water for drinking, utensil and hand washing will be provided m my booth by the following methods6 <br /> Approved bottled water <br />QOn-site hose bitthat is connected to a polable water source <br />7 <br />8 <br />9 <br />meats, tamales, cooked beans, rice, <br />FJJC 76t 11 T6MP EVENT Aep <br /> Camp stove <br /> Double steamer <br />O Eleckic stove top <br />1 am providing a booth with the following (to protect my unpackaged food and food-preparation areas from f^es. <br />dust and Hie public) <br /> Stemo & hotel trays <br /> Steam tabled lids <br /> Omer (specify) <br />finSiYs . Phone Lr_2JLLl <br />Z-O____ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of thlS checklist to <br />Sundays <br />Year Round ------/ <br />O A booth with wals and eeiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screen,ng. completely enclosing open food areas It will also have a smoeth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood ate acceptable) and constructed to separate food and food preparation <br />areas from the public <br />J^Other (specify) ^J/ <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 />enq tS-02 <br />riawtfl <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> OthCf (specify) _________________________________________________ <br />Electricity <s provided for my booth's use U Yes p^No <br />I am providing an accurate probe thermometer to mMsure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation O Yes CS^No <br />I am providing the followlirg hot temperature control for the hot holding of aJk potentially hazardous foods above <br />13ST <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks priorto this event <br />. Weberstown Farmers Market1 Nameof Event ,,____ k _ —•—■ ......■—— <br />The blowing is infonrationabout my organlzation/bus'ness <br /> Alternate: (^ ) <br />Lst food to be sold orgwen to thepublic <br />1 am providing food that is NOT prepared at home No <br />A# food s prepared on-site or is from approved commercial facilUes. ^Yes E2 No <br />Name of facility 1Y5 n' * <br />Addressoffaciltty 1