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TEMPORARY FOOD VENDOR'S APPLICATION <br /> ICJ) food vendors(both for profit and non-profit)are required to retum a signed and completed dopy of this Checklist to <br /> the festival coordinator thrm(3)weeks prior to this event. <br /> t. 1.Name of want: Downtown Tracy farmers Market _5a:irdayi Year Px,nd <br /> Datca{s)_ <br /> 2. The following is nfwrnation about my organization.+husinass: <br /> Name of Organ M lon/buslness: Pyrarrlid Bakery <br /> Address. 1721 Duncan Dr., Tracy, CA, 95376 <br /> Phone: ( 443 ) 220-4864 <br /> Allemate: ( ram) 3043372 <br /> I List food to be sold or green to the public: Bak a --MiddleEa rn wets ' <br /> 4. 1 am providing food that Is NOT prepared at home: ❑Yes D No <br /> All food is prepared on-slie or Is from approved commercial facilities; D Yes❑ No <br /> Name of facaity. Phone: j } <br /> Address of facilrt3r. <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files, <br /> dust and the pubbc) <br /> ❑A booth with vi-aMs and coang consuucted of either wood, canvas, plastic, similar material and fine mosh fly <br /> screening, completely endosing open food areas. It will also havd a smooth and cleanable floor (concrete, <br /> asphalt, dean) tarps and smooth wood am acctspfable) and constructed to separate food and food preparation <br /> areas from the public <br /> ❑other(specrfy): <br /> Nato: The only operations not reguted to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from (approved sources. <br /> 6. Approved wafer for drinking, utensil and hand washing will ba provided in my booth by the following methods: <br /> ApptiAmd bottled ester_ <br /> ❑ Or"Ile hose bib that Is connected to a potable water source. <br /> ❑Other(specify): <br /> 7, E]cdriclty Is provided for my booth's use: ❑ Yes ER No <br /> B_ 1 am providing an accurate probe thearsometer to measure the hot and cold holding of potentially hazardous <br /> foods during aA times of booth operation: ® Yes ❑No <br /> 9. 1 am providing the following hot tcamperature control for the hat holding of all potentially hazardous foods above <br /> 13W., <br /> ❑Camp stove ❑ Stemo& hotel trays <br /> ❑Double steamer ❑ Steam tl3W b 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 /> ".I.._ r NT kW �\ <br /> C-M r'*c�7 d t t trMy Ev <br />