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TEMPORARY FOOD VENDOR’S APPLICATION <br />t Name of Event1. <br />2 <br />Address: <br />Phone: <br />^c-1 rftfo)3, <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will he piovided in my hootn by the following methods:6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice. <br />Pao«7<xii <br />TEMP EVENT APF <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Seulfj iy. <br />1 ho' a"<’ ”,'s <br />I am providing the fallowing hot te^nperature control for the hot holding of all potenfelfy h fcartous foods above <br />J 50 i - <br />___Oate(s); <br /> Approved bottled water; <br />O On^ste hose bib that is connected to a poteble water source. <br />S Other (speafy}; ^1,A <br />Electricity is provided for my boottfs use: Yes E No <br /> Stemo & hotel trays <br />O Steam table 8. lids <br />® Other (specify) m/x <br />Note: Examples of potentialy haaaidous food include* <br />vegetables, potato salad, eggs, and dau y product*. <br />£HO M-02 <br /><11% 13 <br />i , <i_o <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weefc prior to this event. . <br />Weberstown Farmers Market <br />The following is information about my organiaattonfousineaG: <br />Name of oiganization/business; C, Vx A <br /> <br />( Alternate: ( ) <br />List food to be sold orgiren to tnepublio: Cffi) yjrvrttC fC ftD | <br />I am providing food that is NOT prepared at home: E Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility ?<xA <1 Phone. <br />Address of facility ia\ t /tV-t <br />I am providing a booth with the following: (toprotect my unpackaged food and food-pieparabon areas horn flies, <br />dustand the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, simiar material and fine mesh fly <br />screening, completely enclosing open food areas it will also have a smoath and deanable floor (concrete, <br />asphalL dean tarps and smooth wood are acceptebte) and constructed to separate food and food preparation <br />areas from ttie public. <br />E) Other (specify): M driA \a a <A1J <br />Note: 7he only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispenseis, or prepackaged foods from approved sources.