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P. 4No. 4823 TEMPORARY FOOD VENDOR’S APPLICATION Date(s); 10/20/17I.Name of Event:1. 2. Address: Phone; 3. 4. 5. 6. O Approved bottled water. On-site hose bib that is connected to a potable water source. 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENTAPPPage 7 of 11 Q Sterno & hotel trays Steam table & lids Other (specify) Received Time Sep. 28. 2017 9:50AM No. 2372 7/23/10 Camp stove Double steamer Electric stove top Note: Examples of potentially hazardous food Include: vegetables, potato salad, eggs, and dairy products. List food to be sold or given to the public:^ Sep. 28. 2017 9:5 1 AM Other (specify):-------------------- ------------------------------------------— Electricity is provided for my booth's use: Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: IZX^es Q No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: The following is information about my organization/business: Name of organization/business: As Good As It Gets Catering and Events 7&2O 7/tHi J crtry Ca. ^530^____ Alternated )___________ ______ I am providing food that is NOT prepared at home: ^Yes No All food is prepared on-site or is from approved commercial facilities: ^.Yes No Name of facility: W/U5T Phone: IP 55^5-------- Address of facility: TO rxCL'V L\ \/^ X~ t (Jd - S^Q_ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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. KI Other (specify): Tracy Transit Station - Conference Rm 103 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: 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