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4 , <br /> a <br /> 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 /> 1. 1.Name of Event: Downtown Tracy Farmers Market Date(s): Year round <br /> 2. The following is information about my organization/business.- <br /> Name of organ izationlbusiness: Kay's Creations <br /> Address: 535 W Cancion Ct, Mountain House, CA, 95391 <br /> Phone: ( 510 ) 600-1240 Alternate: ( } <br /> 3. List food to be sold or given to the public: French Macaron, Cheeseburger Lumpia, Birria Lumpia, Shrimp plate. <br /> 4. 1 am providing food that is NOT prepared at home: ❑x Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: x❑ Yes ❑ No <br /> Name of facility: La Comisaria Phone: ( 209 ) 338-3663 <br /> Address of facility: 1211 S 7th St. Modesto, CA,95351 <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 walls 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 o separate food and food preparation <br /> areas from the public. [ ;� 5 y—i C�-b-:� <br /> x❑ Other(specify): Food trailers <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 /> [-xl 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: x❑ 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: x❑ Yes ❑ No <br /> 9. 1 am providing the following hat temperature control for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> ❑ Camp stove ❑ Sterna&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 /> EHO 16.02 Page 7 o1'i 1 TEMP EVENT APP <br /> 08/01/16 <br /> O � <br />