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HomeMy WebLinkAbout15-015 Treasure by the Sea{ ; �15-01� � � 2015 Vendor Application ����o��� � �� MAY 14 2p 15 � (Processed & Potentially Hazardous Foods) ; Bass River Farm Market HEALTH DEPT. ,:� � :� 311 Old Main Street, Bass River, MA 02664 � '%.��Z� �. � � 2015 Market Dates: Thursdays,June 11-Sept. 17 9 AM-1:30�PM� Saturdays,June 13-Sept. 19 9 AM- 1:30 PM � 'hs ' Rain or Shine I i ! Name: � �p��,! �,n �#�� 10� (�n�a�o, Farm/Vendor Name � 1�Qc��.ie 8�-t�z.. `��.. - �cn-nn � i ei l� Farm/Business Address t b i►tlP;r �� � � �cz.lmrx.�-f� , M�4 o a���,� � Farm Website: � Telephone (Work) (Home) ��s� 4RS-oa�-� (Celi) Email: �e.1cn���emt�� ver+�a� . n f - Best way to contact you �-mc� 1 �� ec�� Names of Designated Person(s� in charge seil�ng at the BRFM* *Person in charge is responsible for all operations and must be on site from 8:30 AM -1:30 PM and be a iiaison for all correspondence between town officials(health, police,fire) and the Market Manager. _ ,�o�r.le�m.���ta,--t �ma� Phone �SC>�� 4 9 5- oa�f �l Phone �°�)- `�4�� °��`Y Produce/Product you will be selling: (List all. Use separate page if needed. Packaged food items must have potential allergens listed as well as ingredients). Labels should have vendors name and address. ..r�. l� ' 1. Please make your check payable to the,Bass River Farmers Market 2. Your 50% deposit+ Board of Heaith Fee of $50.00 * must be received by April 30th to reserve your space. * Separate check made out to the Yarmouth Board of Health 3. All full season vendors must be paid in full by May 20th. , ��: By si�ning this form the vendor acknowledges that he /she has read and wi11 comply with the guidelines for the 2015 BRFM which are . . available on our website. www.bassriverfarmersrnarke#.org (hard copies on request) Applicants Signature �' i.�,�-, � -� Date �- ��- �,5' Please return completed application to: Bass R�ver Farrners Market PO Box 1374 South Yarmouth, MA 02664 Market Manager: Carlene Veara (774) 217-1067 � � � � , ' . ; � � Samples Prov�ded? (Explain methods of serving samples: sizes, covered, iced?) i ; -- � � ; Where will food be prepared? � Check & attach copies with application: �.. Copy of most recent inspection report of facility where food is prepared � ,;� Product Liability Insurance �-----�ServSafe Certification ' �-food Allergy Awareness Training Certi�cation _ G.A.P.Training Certificate (Required as of 2011) I _ Complete and attach Workers Compensation Affidavit. Attach State Shell�sh Certificate, if applicable I Any additional items must be approved by the Health Director prior to being � � sold at the BRFIVI. Please notify Market Manager at least one week in advance or ' by 10 AM on Monday preceding the Thursday Market and she will get clearance for you. Full Season Fees Thursdays — $200.00 Both Days - $375 Saturdays — $200.00 A 50%non-refundable deposit is due by Apri130, 2015. Final payment is due by May 20, 2015. All full-season vendors are expected to attend weekly. If a seasonal vendor does not show up at a Market and has not given notice to the Market Manager,that vendar will receive notice from the Market ManageK that his/her space is forfeited for the rernaining season.There ace no refunds. Educators, Master Gardeners, No charge NON PROFIT and Authors and Sustainable Living EDUCATIONAL GROUPS advocates to share and display their knowledge and work. � Must be approved by the Market Manager 1 I i ' I i � ! .,. � � ------ �-- __ ___ _. — _ . __- -- ,I ���� --•�.... � Cert�ficate af Achievement � �J �� 1 This certificate is awarded to iosenh I°�-- - � Congratulationsl You have completed �,,,,�,,�„ ServSafe� Food Handler � �'�' Employee Food Safe#y Online Course and Exam ( ' . f �tONA.t. �„��-�tp v,�,�. 1 n����s ,�N 4/19/2013 I RESTAURANT ---- ASSOCIATION� F,r,�„,,„,a,, 4f 1 A/�n 1 R I 175 W:ackson Bivd;Ste 1500 Chicago++L 60604-281d �.800765.2122 , = .�� �°-�:., . � ��:vw.restauranl org�www.ServSafe.com . �;�,��, , ,,,_;;�� ,.. � `:�� . „ ..��:�,`, .:��� �.�� �.,, ,, " , . � r ��� r� y.�,,e. � y���.c � �Y�c � S'�.'`�� � �n�c ' v t-� j� -s r n� ` >,� � r n �. e� .�� 5 .r � � . . � .� � � . � i n n :`��. � r �.�'�`G��-C.��`�G'�9•C.�'�`��9-e�J`'G��-elJ`'G��'' �`�'� �, .:..:......�_.�., _.� ,�.�s�.�,z.,���>>�.,� „ �-�...., . ..........::. . :. ..... ..r,- - ., .�� : ,��: r ��; . �4 ► � � ;-l.����� �nc���--. r, r � M `� � ��� YY �<., , p � .:.�,.r- � � �r ,A� . �: \ - ,. : � � � .�-.-E-����" ����'� C ` •- :R> !: : �1 • „�` �Jj�y ♦ `� �.y `K �C�. ► ^/ ��y,a � � � � r`.+ � �+ � ` \ . � � u � • �a �:V ti . � ► :C��.� a;: ��.����G - r � !'. • s � -�'I . s si „�` ��y. � �b em .'j� � { �/C�.► � � !' � � �.�N � '.� :-F�3�� �vfK��.', � • �.> � � � �• �� , � �Yy ��,., � �-��� �. ,��r� ; r _ k + �,�y �� '., �i4����� • ��'���'�. �. C � � l'> p ^( <. � �= � � •�-lc�.., t��>.*� ,�� . - ��,. � �. �.� a ;;���,�G ' ����-�= <. � .> , � - '�<� �� �� Yy �[,:. � � ..,a� �r� =a�, � ��� ..�� � � , ._��,�31"� �CH�+i. �n :, {� f�� )Y ......���\��� �, . J / �C�. �...,. - �.,....�.�, . ., ,s_.ss�.,:� . ....-,� � ..T'_'---r -:�r:-,�....n-�- .._....- :.:.,:: �. _,. ����.. .� :� � .G\�,.fC�/c�'6��t,C./"�`.'G�..�t..rC/7c '6'�\��,C��•G�.��.,C/��. ��+ �� rU�-c t� rv�-c. � r�r. t� r�-c t� � rv�-c �7 r�c. `��.-. ���C y ,�"C y ��� } ���C ;}; ��� } `7��� r � i � � � � � .� � THE COMMONWEALTH OF MASSAG'HUSETTS � NiJMBER TOWN OF FALMOUTA �g � 159-I S BOARD OF HEALTA �ZS i � PERMIT TO OPERATE A FOOD ESTABLISHMENT I Fermit No.159-15 '' Daie: January 2Q 2015 1n accordance with Reguiations promulgated under authority of Chapter 94,Section 305A and Chapter 1 l l,Section 5 of the General Laws a Permit is hereby�anted to: Treasure by the Sea Whose place of business is: 10 Tiller Drive East Palmouth Type of business and any restrictions: Residentiat Kitcden "I'o operate a food establishment in:Falmouth PF�rrExPmEs: December3l, 2Q15 David Cari-gnan—Health Ageat Falmouth Board of Health � , , ` . �, � t i f��, ��. � ,� ��° � . � • �� � , � � � � 1 � ��' �`� °�� � Y � 6y�a j � ����� , � � :� ; `��� � �� � k ,�,�'�x' '. �t % j . ?'j� ��sF�� 5 1 � � ��� . i � . � � � 1 i � •T�i � � }��� � I •, ��� { � ..� ��5� �4 � $t'�bt� ��r I •� �' � t'�� � 1 .� !' �l� 1 � ` S°k �. � . . . � ��� �',� �. �. ; t a +.� � �' c V'� �� ' � � . .. � � � . . . .r� ���.,� � � � (" x C ��' � �t` +c�, � �j . . �t � ', . . � � �;�� �.,u . . � � � � � � �Ka �tp 4 ` � � w�..�� � � 'r� �� � � . � � � . . . � . . �� . . ,.:�` ' !r .�.. � U ° � � ��� � a { , � � /T =� � �1-- � .� EA : � � `-= � � :� ` _ �. . �� , .� , . � ���= � �. �s,; � � � i � ��.:� � � � �: ,.� • �,�, 4 . . /.. ;P.. . � . . r+ . \ / :*� � . . wrr _Z. . � .. � . �'+. . . . ..^J'✓I�fJ'J.l./f1'1'.r � ��" �. ^ � ��e tl� � ; x., . . �1 �,= ��� � • C.__. ' .1`' :... � - . . � ::�.�'"d:, .. �.Gt. e� . ' ... . . >c:` K- . . . . ,. , . • _... � , . .: :.::.., ,c _<� . . � '�`�A - /�� . . . _�` .. 1 ( i . � . � � l � � � � � i . i � � � � � � � � j ' ,� . . � . � � � . . _- . . . � I • . . . . .` . . _ ; 237 ' JEAN E TEMPESTA �-aa�n�s DBA TREASURE BY THE SEA 9�s 10 TILLER DR y'�7'�� '' EAST FALMOUTH�MA 02638-4900 Date ' . , .�--- $ 5C}.°� Pay to the i/' T-�. o�'d a�S � �'{� �eY Of T� �� s , � n� �oo -------_"". Dollars � a krs"o� �; I ° �-----, � QCKLANDTRUST � � �� � ' ._ _ ..._�._����:�_-- __..� , For ; i �■ 0 237 � � � ; : � . � , , t � � ,M.,.-. � --��....:� ,_ __._ ' �\ � � THE COMMONWEALTH OF MASSACHUSETTS � TOWN OF YARMOUTH � BOARD OF HEALTH PERMIT NUMBER: #15-015 FEE: $50.00 � � This is to Certify that Jean Temi esta, Joe .o go d/}�/a Treasure By The Sea � 10 Tiller Drive, East FalmoLth, MA ; � IS HEREBY GRANTED A LICENSE ' For NAME OF EVENT: Bass River Farmers Market DATE OF EVENT: Thursda,ys and Saturday t ro gh to e�tember 19�.2�15. LOCATION: 311 Old Main Street. South Yarmouth, MA FOOD SERVED: Jams,jellv,and scones. This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts;and expires September 20,2015 unless sooner suspended or revoked. � Mav 15.2015 BOARD OF HEALTH: J[uzr�.a 1�Cu�xteRuet, ��,�c�vureart ; :�'�i�axd J`3a�s��./lR..`l�., 21 ice C'f�ai�cnuzn ' Ei'�eecJ.rt.J- J. Bruce G. Murphy,MPH . ., CHO i Director of Health � . ; � , _ __ _ - _ � _ ._ _ _ , � , j .