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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and norrproflt) are raquifad to return a signed and ccrnpteted copy of this checklist In <br /> th,a festival coordinator three (3)tvDeks prior to this orront <br /> Saturdays <br /> 1. 1.Name of Event; Downtown Tracy Farmers Market _ ^^ Date(6k Year Round <br /> 2. 'nw following is 1Normatlocl about my organtzAL604 �uslness: <br /> Name of cWnZatiorll "ness: Rosa'S Portuguese Bakery <br /> Ads; 2251 Jackson Ave Escabn, CA 95326 <br /> Phone: { 209 )485 - 2943 <br /> 3 List foal to be sdd cr given to the public: Paslrlos and other baked goods <br /> 4. 1 am pruvIdtng food that Is BOT prepared at hma, �11 Yes ❑ No <br /> An food Is prepared on-si:e or Is frcm appmved comm©rdat faciFtim: ❑Yos❑ No <br /> Name of facAMly Rosa's Portuguese Bakery Phone: 209 4 B 5-2943 <br /> Address of facility.2251 Jackson Ave Esc alon, CA 95326 <br /> 5. 1 am providing o boolhwdh the follmving: tin proled my unpackaged food and food preparation areas from fifes, <br /> dust and the public) <br /> ® A booth with watts and celblg corrstlucted of either wood,canvas, plastic. similar materiel and fine mesh fly <br /> screening, completely antilosi g opon food areas. It vei'.l aisa have a smooth and cWarobte Floor (concrale, <br /> asphalt, clean larps and smooth vAxO are acceptable)and corstiucted to separale food and food p(oparatiun <br /> efeas from the public. <br /> ❑CKhar{spmlfy): <br /> Note. The only operations rKA required to provide enclosed booths aro those %filch sell beverages from <br /> approved dispenso j,or prepwxaged foods from approved sources. <br /> 6. Approved watef for drinking, utensil and hand wnshing vAil be provldod In my booth by the following methods: <br /> ®Approved baWed water, <br /> ❑On-site hoso bib that is 000rseded to a polablo water souxcol <br /> ❑01har(5pecify); <br /> 7. Elactdcll} Is p+ovided for my booth's use: ❑Yes❑ No <br /> 8. 1 am panf*fnlg an mate probe thefrnometer to measure tho hot and cold holding of polantiatly h5jzrdocrs <br /> foods during ail trees of booth operaton:N Yes ❑No <br /> 9. 1 am pit i wig Iho fallowing hot temperature eonlrot for tf10 hot holding of all potentially hazardous toads above <br /> 135'F: <br /> ❑ Camp 6tova N/A ❑ Sterna &hotel trays <br /> ❑ boubie staorner ❑ Steam tsWe &lids <br /> ❑ Ekc4ria stove Iop ❑ Olhar(specify) <br /> Note: Examples of poteirbially hxwdauz food Include: meats, tamales, cooked beans, rice, <br /> vegotablos, potato sated,eggs, and dairy product9, <br /> Fla MM PlGe 7 d 11 TEM,EVENT MP <br /> Od91r19 '�, <br /> i <br />