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TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profd)are required to roWnn a signed and completed copy of this checklist to the festival coordinator throo(3)weeks prior to this event 1. 1.Name of!~vent: Downtown Tracy Farmars Market � Data(s): Y°ar round 2_ The following Is Information about my organ mallonlbusiness: Name of organizadowbusiness; Kay's Creations Address: S35 W Caexcon CL Mountain House.CA,95391 Phone: ( 510 ) 6W-1244 _ Altamale:( ) 3. List food lobe sad or given to the public- French Macaran.Cheeseburger Lurnpia.filrria Lumpla,Shrimp plate. 4. 1 am providing food that is M prepared at home: x Yes ❑No All food is prepared on-site or Is from approved commercial facdtities; F-1 Yes❑ No Name of faciity: LA C lffum zi _ Phone: i 2D9 1 33a-3m3 Address of facaity: 1211 S 71h SL Modosio,CA, 95351 5. 1 am providing a booth with the fabowing: (to protect my unpacksged food and food-pmpamtion areas from flies, dust and the public) ❑A booth with walls and celling constructed of either wood. canvas, plastic, similar matenat and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and clemwabte floor (concrete. asphalt, dean tarps and smooth wood are acceptable)and consWX10d to separate food and food preparation areas krn the public- ® Other(specify): V Note: The only operations not required to provide enclosed booths are those which sell beverages from appmwd dispensers,or prepackaged foods from approved sources. 6- Approved water for drinking, utensil and hand washing wlil be provided In my booth by the following methods: ❑Approved bottled water. x❑On-site hose bib that Is connected to a potable water source. ❑[litho(specify): T Electricity lis provided for my booth's use:[E Yes❑No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentialy hazardous foods during all times of booth operatlon: x❑ Yes❑ No g. 1 t1m providing the following hot temperature control for the hot holding of aA potentially hazardous foods above 135'F: ❑ camp stove ❑Sterna& hotel trays ❑Double steamer ©Steam table& lids ❑Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food Include: moats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. EhD 14-C2 Pape 7 d 11 cbt rr16 TEW E'pfr APP