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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-p(ofit) are required to return a signed and completed copy of this checkist to <br /> this festhral coordinator three(3)weeks prior to this event_ <br /> Downtown Tracy Farmers Market Saturdays <br /> 1. 1.NameoTEvent �Y _ Date(s): Year Round <br /> 2. The following Is Information about my organizationlbusiness' <br /> Name of organlzatiarubu sin oss: Speedy's Potatoes <br /> Address: 3 E Gibson St Stockton, CA 95204 <br /> Phone; ( 831 )406 - 8956 Alternate:{ ) <br /> 3. List food to be sold or given to the pubtrc: Baked Potatoes, Roasted Corn <br /> 4. 1 am providing food that Is NOT prepared at home: [Z Yes ❑ No <br /> All food is prepared cresite or is from approved commercial faailties: ® Yes []No <br /> Name of facility. Phone.- <br /> Address of facilibf.. <br /> S_ 1 am providing a booth with the following: (to protect my unpackaged food and food-prcparatlon areas from flies, <br /> dust and the public) <br /> ® A booth with walls and ceiling constructed of cKhcr wood, canvas, plastic. similar material and fine mash fly <br /> screening, wmpletcly anr3osing open food areas. It will also have a smoa4h 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): <br /> Nola: 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 /> $. Appnaved water for drinking, utensll and hand washing Will be provided in my booth by the following methods: <br /> ®Approved battled water <br /> ❑On-site hrssa bib that is connected to a potable water source <br /> ❑ Other(speafy): <br /> 7. Electricity is provided for my booth's use:❑ Yes❑ No <br /> B. I am providing an accurate probe thermometer to measure the hot and cold holding of po;entielly hazardous <br /> foods during all times of booth operation: ®Yes❑ No <br /> 9. 1 am providing the following hot temperaturo control for the hot holding of all potentially hazardous foods B.bove <br /> 135'F: <br /> ❑camp stove NIA ❑ Stem°&hotel trays <br /> ❑ Double steamer ❑ Steam table a Ilds <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examplas of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs.and dairy products. <br /> EHQ 1607 Pale 1 cr 71 T"JP FVFNFT APP <br />