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TEMPORARY FOOD VENDOR’S APPLICATION Girls Night Out - Witches and BroomsticksI.Name of Event:1. 2. Address: ( 209 ) 399-0888Phone:Alternate: () Teriyaki Chicken Skewers, Sweet Chili Italian Meatballs, Macaroni Salad, Fruit Cups, CharcuterieList food to be sold or given to the public:3. 4. 5. Other (specify): 6. On-site hose bib that is connected to a potable water source. Other (specify): 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APRPage 7 of 11EHD 16-02 7/28/10 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ^S^Approved bottled water. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Camp stove Double steamer Electric stove top J^Sterno & hotel trays Steam table & lids Other (specify) The following is information about my organization/business: Name of organization/business: ^aVs Gourmet LLC 880 W. Mount Diablo Avenue, Tracy, CA 95376 Electricity is provided for my booth’s use: YesJ^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. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operationYes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) J^A 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 food that is NOT prepared at home:]^/es No All food is prepared on-site or is from approved commercial facilities: £^Ves No Name of facility:Phone: (1 Address of facility: Date(s): 10/18/24