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TEMPORARY FOOD VENDOR'S APPLICATION <br /> M food vendors(both for profit and non-profit)are required to return a signed and eompieled copy of this checklist to <br /> the fe5lival coordinator three(3)weeks prior to this evonL <br /> Saturdays <br /> 1. 1,Name of Event Downtown Tracy Farmers Market Q-att(a): Year Round <br /> 2. The following is information about my organtzatioNbu_sinam: <br /> Name of organizatio"usiness: - Ferment And Grind <br /> Address` 894 Golden Pond Dr Manteca Ca 95366 <br /> Phone: ( 209 ) 604 - 6574 Alternate:( ) <br /> 3. List food to be sold or given to the public Sourdough Breed <br /> 4. i am providing food that is NOT prepared at home:[Z Yes ❑No <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yes ❑No <br /> Name of facility; Ferment And Grind Phone: <br /> Address of faaiity:894 Golden Pond Dr Manteca Ca 95366 <br /> 5, i am providing a booth with the fo$owing: Ito protect my unpackaged food and food-preparation areas from files, <br /> dust and the public) <br /> ❑ A booth with walls And ceiling constructed of either wood, canvas. plastic, Sin-War 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): NIA Prepackaged Goods <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.utensA and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water <br /> ❑ On-rile hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Efetbric ty is provided for my booth's use: ❑Yes ❑No <br /> S. l am providng an accurate probe thermometer to measure the hot and sold holding of potentially hazardous <br /> foods during all times of boodl operation: ®Yes❑ No <br /> 9. I am providing the Wowing hat temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F. <br /> ❑Camp stove N/A ❑ 5temo a hotel trays <br /> ❑ Double steamer ❑ steam table 8 lids <br /> ❑ Electric start 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 1642 P&2a 7 of 11 1 EMP EVENT APP <br />