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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3) weeks prior to this event. <br /> Saturdays <br /> Downtown TracyFarmers Market Year Round <br /> 1. 1,Name of Event: �Da#e(s): <br /> 2. The following is information about my organization/business: <br /> Name of organizafon/business: 5 N '� L C- N 4 R G Ft P. <br /> Address: y 1AJ . A w,e,t o " +t G " H �n; w 14 b, s r C/A. . 9 S 3�! <br /> 63 a %4,6 <br /> Phone: . ($SS ) '{ - 5►J a VJI E (474-6143}Altern2te: ( 650) 1-3 -Sv 6 g 1 <br /> 3. List food tobesoldor given to the public: �k yr C r , �1iL; J�Qk,,lS �'�4cr. 140t. tot«a. <br /> 4. 1 am providing food that is NOT prepared at home: (K Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Q Yes❑ No <br /> Name of facility, i rwG -j O A.1 e- Phone: 00 U <br /> Address of facility; 3'% 5+ C t r r a <br /> S. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) C C � 2 n �0 ) <br /> ❑ A booth with walls and ceiling constructed o either wood, canvas, pl ic, simililar 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. M b 0(4 1 c, Y Sc I{ - e Q%+ t.9 ,v,•j l<,1 cti.C_H jj <br /> ® Other(specify): ­j % kV L ,Q 1 5 i c, n, 01 a e 0 Q+ k , <br /> v + F <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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water, <br /> ❑ On-site hose bib that is connected to a potable wale source. rr <br /> . 4,-1..s �� -- <br /> I <br /> [ Other(specify): A c w a 1�)u ti f r w< < C.r <br /> 7. Electricity is provided for my booth's use: 1[Yes ❑ No <br /> 8_ 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: I(A Yes❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑camp stove ❑5terno &hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑Electric stove top [j Other(specify) to , A f <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooped beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> EHO 16-02 Page 7 of 11 TEMP EVENT APP <br /> 08/01116 <br /> 1 <br />