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TEMPORARY FOOD VENDOR’S APPLICATION Year Round1 Name of Event Datefs):1. 2. Phone: List food to be sold or given to the publi<3. 4. 5 Other (specify): 6. 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPageTof 11EHO 16-02 08/01/16 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ^Approved bottled water. O On-site hose bib that is connected to a potable water source. The following is information about my organization/business: Freshway Fish Camp stove Double steamer O Electric stove top Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Stemo & hotel trays Steam table & lids Q Other (specify) Other (specify): Electricity is provided for my booth's use: O Yes,^ No 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 Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing the following hot temperature control for the hot holding of aH potentially hazardous foods above 135*F: I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods dunng all times of booth operation: ^\Yes No I am providing food that is NOT prepared at home^J Yes No All food is prepared on-site or is from approved commercial facilities: £3" Yes No Name of facility: Commi t Phone Address of facility [2-0 I am providing a booth with the following; (to protect my unpackaged food and food-preparation areas from Hies, dust 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, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Name of organization/business: Address 1/MhiNgfoN <Cui4-o mevillc ca __ Alternate: (^/l/J ) l~1 • 2-1 g>~f- icftmnW/1 .fafluloM Spftpo A. .CryiolM’^ Rht i flhf chip?