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Date(s)1.1. Nameof Event <br />2 <br /> <br />Address <br />Phone <br />3 <br />4 <br />•ij <br />S <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods8 <br />O Approved bottled water. <br />OOn-site hose that is connected to a potable water source <br />7. <br />8 <br />meats, tamales, cooked beans, rice, <br />Page Totil TtMP EVEhT APR <br />exo ts-cj <br />oewim <br />0 Camp stove <br /> Double steamer <br /> Electric stove top <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fl'ess <br />dust and Hie public) <br />O Stemo & hotel trays <br />O Steam tabled lids <br /> Other (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 smooth and cleanable door (concrete, <br />asphalt dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />JS^Other(specify) fijl <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 />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this cneckist to <br />Sundays <br />Year Round <br />D Other (specify)_ _____________________________________________ <br />Electricity is provided for my booth's use Q Yes <br />1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation Yes <br />I am providing the followlt*g hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F .. / <br />the festival coordinator three (3) weeks priorto this event <br />Weberstown Farmers Market <br />r-“—ts—*------------------------- <br />The folowing is information about my organizationfousiness: <br />Name of organizakonfousmess' <br />£5 ---- - <br />____ Alternate: ( <br />1st foodto besold orgwen to thepubhc <br />I am providing food that is NOT prepared at home j^yes No <br />AJ food s prepared o n-site or s from <br />Name of facility <br />Addressoffactlity < <br />approved commercial facilties. S’Yes No <br />Phone (1^11 I -T-ZlLl <br />o G>l/e.< • <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.