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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profa) 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 /> 1. 1.Name of Event Downtown Tracy Farmers Market Date(s): Saturdays Year Round <br /> 2 The following is information about my organizationlbusiness: <br /> Name of organization/business. Slack Kat Cafe Company <br /> Address 3`� 2S V-er n'a.ZZ C_ C r Ag.A, Ca Gam- 4 53"3 <br /> Phone: (ZO') Ep 10 G ' 1577 Cf-L- Alternate. ( <br /> 3 List food to be sold or given to the public__QWIA_.4te-5 -;r <br /> 4. 1 am providing food that is NOT prepared at home. ®Yes❑ No SG,i <br /> All food 1s prepared on-site or is from approved commercial facilities 0 Yes[]No ZZS- t3 q3 <br /> Name of facility eCLLQa &Qd ce_ Phone. QLa <br /> Address of facility:.f$Obi 61Gckdeer L--oe $ F Tenrfe c,&a_ [/N- 9.�a_!-2 9 <br /> 5. 1 am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> �*A booth with wails 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. <br /> ❑Other(specify): <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 water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑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: ®Yes ❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad, eggs,and dairy products. <br /> EHD 16-02 Page 7 W 11 TEMP EVENT APP I <br /> 08101 ri6 <br />