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TEMPORARY FOOD VENDOR'S APPLICATION <br /> An rood vendors(both for profit and nonprofit)are required to retum a signed and eomplIeted copy of this checkbsl to <br /> the festival coordinator three(3)weeks prior to this event Saturdays <br /> 1. f.Nam a of Event-. Downtown Tracy Farmers Market oaws). Year Round <br /> 2. The following is Informatlon About my organtwbontusiness: <br /> Name of organ lzatdonlbuslness: Ferment And Grind <br /> Address: 894 Golden Pond Dr Manteca Ca 95366 <br /> Phone: ( 209 ) 804 - 657'4 _ -- ._ Alternate:( ) <br /> 3. List loud to be sold or given to the public <br /> Sourdough Bread <br /> 4. 1 am providing food that is NOT prepared at home_® Yes ❑No <br /> All food is prepared on-silo or is from approved commerc al facililles: ❑Yes ❑No <br /> Name of faclW. Ferment And Grind Phone: _ <br /> Address of facility. <br /> Golden Pond Dr Manteca Ca 95366 55 C t�fl <br /> 5. 1 am providing a bootie with the fobowlnp: (to protect my unpackaged food and food-preparation areas from f1les, <br /> dust and the public) <br /> ❑ A booth wth walls And ceiling constructed of either wood, canvas. ptastic,similar material and fine mesh fly <br /> screening, eomptotoly enclosing open food areas. It "[I also have a smooth and cleanable floor (concrete, <br /> asphaft, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparatlon <br /> areas from the public. <br /> ®Omer(specify): TWA Prepackaged Goods <br /> Note: The only operations not required to provide enclosed booths are thaw which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved walef for dunking.utensa and hand washing will be provided in my booth by the fotlawing methods: <br /> X Approved bottled water <br /> ❑ On-site hose bib that 19 connected to a potable water source. <br /> ❑Other(specify): - <br /> 7. Electricity is provldod for my booth's use: ❑Yes ❑No <br /> B, i am providing an aocurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operatlon: ®Yes❑ No <br /> 9. 1 am providing the fo5amng hot temperature conlyd for the hot holding or all potentially hazaudous foods above <br /> 135T: <br /> ❑Camp stave N/A 1/A ❑ Sterna 3 hotel trays <br /> ❑ Double steamer ❑ Steam table a lids <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 /> PsQa 7 cr t t <br /> TEMP EVEN-T APP <br /> E HD 1"2 <br />