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1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />O Approved bottled water. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 at 11 At*EHO 16-02 <br />(W0V16 <br />JS Camp stove <br /> Double steamer <br /> Electric stove top <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />.urge. / / j <br />li Z <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />^efSvaTedOrSH(bO,h for profi' and non-profit) <br />me festival coordinator throo ii\ ' <br />Q On-site hose bib that is connected to a potable water soun <br />xf'J Other (specify): I 1^6 t/f/ tfuy 1 - <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: yj Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135aF: <br />qq .. r - - - — — iaro raquired io return a signed and completed copy of this checklist to <br />ven' Sundays <br />1 Name of Event: Weberstown Farmers Market Date(s): Year Round <br />The following is information about my organlzation/busmess / / / Z <br />Name of organizationTbusmess: , f LC C <br /> <br />Address: 2^7 7 / c/ (7/1 7/0^7^ <br />) 22r-3Z/7__________ Alternpte: ) 303' b <br />List food to be sold or given to the public:/ [( J /7'^ <br />I am providing food that is NOT prepared at home: 6^ Yes Q No <br />All food is prepared on-site or is from approved commercial facilities: Yes O No -y <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 />wf 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.