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s 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. Name of Event. downtown Tracy Farmer&Market Date(s)- Saturdays Year Hound 2. The following is information about my organizationlbusiness Name of organization/business: The Lemon Box Address: 478 Providence St Phone: ( 510 )582-61156 __ __ Altemate:( ) 3. List food to be sold or given to the public: Lemonade 4. 1 am providing food that is NOT prepared at home:WYes❑No All food is prepared on-site or is from approved commercial facilities j Yes❑No Name of facility: Phone: Address of facility: 5 1 am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, dust and the public) VIA booth with walls and ceiting 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, dean 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. 6. Approved water for drinking,utensil and hand washing will be provided in my tooth by the following methods, **Wpproved bottled water. ❑On-site hose bib that is connected to a potable water source ❑Other(specify): 7. Electricity is provided for my booth's use:❑Yes Wo 8 1 am providing an accurate probe thermorWer to measure the hot and cold holding of potenbaiiy hazardous ioods during all times of booth operationYes❑No 7, 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑camp stove ❑Stemo&hotel trays ❑Rouble steamer ❑Steam table&lids ❑Electric stove top ❑Other(specify) Note: Exampiea of potentially hazardous food include: meats, tamalev, conked beans, rice, vegetables,potato salad,eggs,and dairy products. EHO 1"2 P&"7 W 11 TEMP EVENT APP 1WN09 SJ C r\4 (L ,,0 S `1 +o �3SO o �