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Date(s):1. <br />2. <br />Address: <br />Phone: <br />3, <br />4. <br />1 <br />5. <br /> Other (specify): <br />6. <br />7. <br />8. <br />9. <br />food include:meats,tamales, cooked beans,rice. <br />Page 7 of 11 <br />TEMP EVENT APP <br />EHD 16-02 <br />08101/16 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Xl Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <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 />of this checklist to <br />Sundays <br />Year Round <br /> Other (specify): <br />Electricity is provided for my booth's use: Yes [x] No <br />5 MS <br />I <br />cold holding of potentially hazardous <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 <br />the festival coordinator three (3) weeks prior to this event. <br />1 Name of Event- Weberstown Farmers Market <br />I am providing an accurate probe thermometer to measure the hot and <br />foods during all times of booth operation: jx^Yes No <br />I am prating the fotlowlng hot temperatum controt for the hot holdthg of all potentially hazardous foods above <br />Q Camp stove <br />O Double steamer <br />|v] Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: --------------------- <br />_CdL --------------------------------------- <br />(^ ) W 7-^^ _______Alternate: ( <br />List food to be sold or given to the publicXo UtixA— <br />I am providing food that is NOT prepared at home: K^Yes No <br />All food is prepared on-site or is from approved commercial facilities. [X. Yes 0 No <br />Name of facility: _________________Phone. (. <br />Address of facility ______ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />A booth with walls and ceiling 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 floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0 Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous f - <br />vegetables, poufo salad, eggs, and dairy proddefo)