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TEMPORARY FOOD VENDOR’S APPLICATION Date(s): 10/24/251.I.Name of Event: 2. Address: 967-3809( 209 )399-0888Phone:Alternate: (925) 3. 4. 5. Other (specify): 6. Other (specify): 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPage 7 ol 11EHD 16-02 7/28/10 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: J^Approved bottled water. On-site hose bib that is connected to a potable water source. Camp stove Double steamer Electric stove top Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. J^fsterno & hotel trays Steam table & lids Other (specify) The following is information about my organization/business: Name of organization/business: ^aYs Gourmet LLC 880 W. Mount Diablo Avenue, Tracy, CA 95376 Electricity is provided for my booth’s use: LU YesJJ^No Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Girls Night Out - Witches and Broomsticks I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:^JYes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: List food tO be sold or given to the public ^er'yak' C,1*cken Skewers, Sweet Chili Italian Mealballs, Macaroni Salad, Fruit Cups. Charcuterie I am providing food that is NOT prepared at home:^p'es No All food is prepared on-site or is from aporoved commercial facilities:£^Ves No Name of facility: Legacy Fields Phone: () Address of facility:2181 N. Tracy Blvd. Tracy, Ca. 95304