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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1.Date(s): <br />2. <br />C C CC CPM rtAddress: <br />Phone: <br />S <^v \ O ci3.List food to be sold or given to the public: <br />4. <br />5. <br />O Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />7. <br />a <br />9. <br />EM01H2 aam/M <br />^3 Approved bottled water. <br />O 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 />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 /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br /> Steam table & fids <br /> Ofter (specify) <br />The following is information about my organization/business: <br />fry 11 t~opi <br />ctrnex/ <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />Sundays <br />Year round <br />M 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 deanable 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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy product <br />the festival coordinator three (3) weeks prior to this event. <br />Weberstown Farmers Market <br />I am providing food that is NOT prepared at home: ^0 Yes O No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility:Phone: (1 <br />Address of facility:____________________ <br />O Other (specify):____________________ <br />Electricity is provided for my booth’s use: Yes^No <br />I 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 Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /><05°F: <br />Name of organizalion/business:_ <br />9)2 1 \ at Kir op <br />(7 Ste c? 72-92-Alternated ) <br />Frvtit looizv IS /-ffoAi t <br />TEMPEVCNT