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TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 1. 1.Name of Event: Downtown'I racy Farmers Market Date(s): Saturdays Ycar Roujiid i 2. The following is information about my organ ization/business: Name of organization/business:JDWA f Jf-E4 P-I JE5 !NG �)'��r J 'S Address: _ � l�E ! 57�: �'� 1 >`1 T ✓±� Cf} `I`- s f Phone: Alternate:( ) 3. List food to be sold or given to the public: '01 INW V W Uri ! I L—r— 4. 1 am providing food that is NOT prepared at home:�Yes❑ No Ail food is prepared on-site or is from approved commercial facilities: 5�j Yes❑No Nameoffacility: film 17L} flWA! C 1G Phone: (ail 7k(. 0/0 .7 Address of facility: �55 1`i r,5T 5;RaE'r r p EtrTWL)n CA 9V 51 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) [9A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. it will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. I 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. ❑On-site hose bib that is connected to a potable water source. i ❑Other(specify): 7. Electricity is provided for my booth's use: M Yes❑ No I 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: ®Yes❑No S. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135'F: NIA ❑ Camp stove ❑Stemo&hotel trays ❑ Double steamer ❑Steam table&lids ❑ Electric stove top ❑Other(specify) f Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. EHb 16-02 Page 7 of 11 TEMP EVENT APP 0&01116 2 • J