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2 <br /> SANAOAQUIN <br /> Environmental Health Department <br /> —COUNTY—, <br /> t p r Grectres: grows herd. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> A11 food vendors (both for profit and noon-profit) are required to return a signed and completed copy of this checklist to <br /> the h2sfmW o"dkiallor 11tdm(M Weeks'prior 0 Ift Ott Saturdays <br /> Downtown Tracy Farmers Market Year Round <br /> 1. 1.Nart�e ol`E�nt: �3a6ea(s}= - — <br /> 2. The following is information about my organ"tion/business: <br /> Name of organization/business: 4tkfAnr►LA,-f lfCa.�� - — -- - . <br /> Address: 1-7 1-0 1X)I in 4 �. _ n cry c -- <br /> Pt KEW. *�o )_ 3 ct Q — LA to 3 — Afturft T <br /> 3. List food to be sold or given to the public:_� iLAAY� "S_ P s is e W-P <br /> A 1 am providing food that is hM prepared at home: ❑Yes C'- o <br /> All food is prepared on-site or is from approved commercial facilities: Yes 0 No <br /> name Of tarty: _ Y.rn l&-S t+f c�.� Pbom 19 3151 u 8-G -- 9,1 8' C� <br /> Address of 14ca; �� 5`_Q -ao k i-tr _ .;Lr L-C f midcn L&— -- <br /> 5. ! am proudi g a booth alas.the followmg: (to protect my urymkaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fide 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 /> fret the MA*C. <br /> A11 <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 /> On-stVte base Ub tbrat is connected to a potable water source. <br /> ❑ Other(spe*. <br /> 7. Electricity is provided for my booth's use: ❑Yes C No <br /> 8. l am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> boas.Curing au WTE%of boom operation: 0 Yes Q nto <br /> 9. r ant provk2n ltie Bakmhg loot Oemperature aordrot for Site trot holding of a3 pokn*afy t=a�roods above <br /> 135°F- <br /> D CWV WVe ❑stu no&beret trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples .of potentially hazardous food include: meats, tamales, cooked Mans, rice, <br /> AMU I1010 <br /> 1868 E. Hazel= Avenue} Stockman, C;Afornia 95205 3 209 468-3420} IF 209 464-0138 1 www.sjcehd.com <br /> EHD 1"2 Page7 of 17 TEMP EVEhn APP <br /> 4713l17 <br /> O <br />