Fergus County Farmers Market Permit Application 03082022

Farmers Market Purveyor Permit Request

Valid for the Farmers Market season for exempted products (not potentially hazardous)

To be completed as least two (2) weeks before FARMERS MARKET event or function
Date of Application

MonthDayYear
Organization's Name
Contact Person's Name
Phone
Cell Phone
Fax
Email Address
example@example.com
Mailing Address
City
State
Zip Code
Signature

Clear
Date

MonthDayYear
Event Name
Location
Dates of Use

MonthDayYear
Hours of Operation
NOTE TO APPLICANT: Complete checklist on the next page of this application.
FARMERS MARKET Food Service Permit:    Approved    Denied
Comments:   Type a label

Sanitarian Signature:   Signature    Date

Fergus County Health Department Environmental Health Services

Purveyor Permit Request (continued)
Check Off Once Completed:

Food Items
List of products to be sold:
Source of the food
List food items that will be prepared at home:
Initial here if you agree to this statement: "No changes will be made without health department approval."*
50-50-102. Definitions.

(1) "Baked goods" means breads, cakes, candies, cookies, pastries and pies that are not potentially hazardous foods.

(15) (a) "Preserves" means processed fruit or berry jams, jellies, compotes, fruit butters, marmalades, chutneys, fruit aspics, fruit syrups or similar products that have a hydrogen ion concentration (pH) of 4.6 or below when measured at 24 degrees C (75 degrees F) and that are aseptically processed,packaged, and sealed.

(b) The term does not include:

(i) tomatoes or food products containing tomatoes; or

(ii) any other food substrate or product preserved by any method other than that described in subsection (15a).

(16) "Raw and unprocessed farm products" means fruits, vegetables, and grains sold at a farmer's market in their natural state thatare not packaged and labeled and are not:

(a) cooked;

(b) canned;

(c) preserved, except for drying;

(d) combined with other food products; or

(e) peeled, diced, cut, blanched, or otherwise subjected to value-adding procedures.

50-50-202. Establishments exempt from license requirement -- farmer's market records:

(3) (a) A license is not required of a gardener, farm owner, or farm operator who sells raw andunprocessed farm products at a farmer's market. (b) A license is not required of a person selling baked goods or preserves at a farmer's market.

(4) (a) A farmer's market that is an organized market authorized by a municipal or county authority shallkeep registration records of all individuals and organizations that sell baked goods or preserves at the market. (b) The registration records must include but are not limited to the name of the seller, the seller's address and telephone number, the products sold by the seller, and the date the products were sold.

(c) The registration records must be made available to the local health officer or the officer's agent.
Should be Empty:

Check Off Once Completed: