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TEMPORARY FOOD VENDOR’S APPLICATION Date(s):1.1. Name of Event 2. Address: Phone: 3 vZ A. 5. 6: 7.No 8. 9. Page? of 11 TEMP EVENT APPEH£> 16-02 0BTO1/16 ■■ M ■ - f:A?“ 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. Other (specify):■ _______ Electricity is provided for my booth's use: Q Yes E I am providing ah accurate probe thermometer to List food to be sold or given to the public: Sundays Apr-Apr Ar-.’- ■ ‘ ' V* I am providing ah accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during ail times of booth operation: Yes |Pf No •■ J. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135T: O Camp stove Double steamer EJ Electric stove top 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 Stemo & hotel trays O Steam table & lids Other (specify) Note: Examples of potential hazardous food Include: vegetables, potato salad, eggs, and dairy products. All food is ptepafed Name of facility: —(/yiy—jr1. y yy*' r>VTUt1 1 1_________ ■ . Address of facility:J .. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, cfost and the public) .. A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, J asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (speoSy):_____ _______ Note: The only operations not required to provide enclosed booths are those which sell beverages from I - - approved dispensers, or prepackaged foods from approved sources. . .. V ■■ -■ :■ meats, tamales, cooked beans, ffoe. The following te information about my organizatfon/business: Name of organization/business: VAMUvMS FMc. CoriQ Q-tll fyftpA p.,W Dy. Xhlfk^ (X ^01 zrr ----- ---------------- Alternate: (^ <MLe..aai .Caffliui. Corn__ I am providing food that is NOT prepared at home: ^Yes O No j-i- -jig or jg ^porrt approved commercial factlrties: Qves O No 11^ .{Mtf Wfa^U^ttlg/fflfAPhone: £J