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-1 •V- - ISS’F: Page 7 of 11 L£UUlUMjSr ‘T ;: < ; i 44*£ Q Stemo & hotel trays Steam teble & lids Other (specify) - meats, tamales, cooked beans, rice, j : - . ■ z TEMP EVENT APP ’ * Jt ?' :/4'/,•■-.-<<•; •iy". ;•?■<. ■' !• ■"■ ; r AS^offac^ity:. r - >• ■ll8- : W «9anfe^mlbusiness: csJ~ ireecK ■■ i ■ i ...i (I’iX — rfaltowiOfl; (tQ.PXQt^wunjWGkaoeci fOQdandfoods)reparat<>oan^frmW«» :'k:’ ; ' ” •■’v \ ■■ -./ .■.< ' t. - TIT.-' IT,' - - T————————— . Alternate: ( )______________ eteo Lye-5 !/< “ —4^ - ' ■'_____ Q Camp stove Double steamer Q Electric stove top . .•* ••...... ■ J . ' Note: Examples of potent laity hazardous food Include: vegetehtes, potato salad, eggs, and dairy products. ' / ■ ■ EHD 18-02 I. WV76 1. 1.Name of Event; .. ■' t-2. ' : Tha foltowing is > Name of organization/busine s: SIaJ xAp- - < . Phone: 12ofr 3$% - 3. List food to be sold or given li the public: V am WfcW1t»d^»at - k«X __ <1 Bi-^rap Address of facilrty: >27<~ _ '«•- fampfthddtog a gooto with tte foltowiofl: (to protect my unpackaged fopd and food-preparatioo areas ftwiM dust and the public) | - ..., . St 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, asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas fromfte public. i . z, Other (specify):;_______________________________________________________. B Note: The only operations riot required to provide enclosed booths are those which sell beverages fopm'- <: ? approved dispensers, 4>r prepackaged foods from approved sources. ? Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: O Approved bottled water, i On-site hose bib that is connected to a potable water source. D Other (specify):_____________________________________________________________ Electricity is provided for my booth’s use: Yes E No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazantous foods during all times of booth operation: Yes £3 No I am providing the following hbt temperature control for the hot holding of all potentially hazardous foods above 13ST: j >h ■ .. ... . ■ r TEMPC RARY FOOD VENDOR’S APPLICATION •. K. ..... . ' " ■/' . . .. ■ • > ■ . . • ■< . . . . . - - ■ AH food vendors (both for profit am non-profit) are required to return a signed and completed copy of thischectmto toe festival coordinator three (3) wefelcs prior to this event. • >. . SSr' Weberstown Farmers Market Sundays Apr-Apr i 6- 'f- ■.V- ••• M