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Date(s): 10/21/22 <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Pago 7 of 11 TEMP EVENT APP <br />5 <br />[pj Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />1. Name of Event: Girls Night Out - Witches and Broomsticks <br />The following is information about my organization/business: <br />Name of organization/business: s Gourmet LLC <br />880 W. Mount Diablo Avenue, Tracy, CA 95376 <br />( 209 ) 399-0888 Alternate^ ) <br />List food to be sold or given to the public: Marinated Chidcen Skewers, Shrimp Crostini. Potato Salad. Fruit, Charcuterie Spread <br />EHD 16-02 <br />7/28/10 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to retum a si9ned and completed “py of this checkfetto <br />1. <br />to measure the hot and cold holding of potentially hazardous <br />Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F: <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: Tracy Community Center __Phone" (209) 831-6201 <br />Address of facility: 950 East Street, Tracy, CA 95376 <br />1 ^s^and the public? 1116 f°ll0win9: (t0 protect my unPacka9ed food and food-preparation areas from flies, <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />areas fromthVpubhc306 Sm°Oth WO°d are accePtable> and constructed to separate food and food preparation <br /> Other (specify):_____________ <br />Note: 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[^Approved bottled water. <br />D On-site hose bib that is connected to a potable water source. <br />Other (specify): /4^[> <br />Electricity is provided for my booth’s use: 0 Yes No <br />I am providing an accurate probe thermometej <br />foods during all times of booth operation: