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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name Of Event Stockton Heat “Breakaway Cafe”1. <br />The following is information about my organization/business:2. <br />Name of organization/business: Town & Country Cafe, Inc.. <br />Address. 27 W10” Street, T racy, CA. <br />3. <br />4. <br />5. <br /> Other (specify): 10x10 area created for TC CAFE <br />6. <br />XO Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />Cambro Hot Boxes to hold hot food <br />meats, tamales, cooked beans, rice, <br />135’F: <br />O Camp stove <br /> Double steamer <br /> Electric stove top <br />7. <br />8. <br /> Environmental Health Department <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Phone: (209 ) 835-6751 Alternate: ( 209)813-5498-------- ----------------- <br />List food to be sold or given to the public: Cinnamon Roll Monkey Bread, Salads, Finger Foods Sandwiches. <br />I <br />Date(s)j <br />XO Other (specify): Hot water in Cambro ------------------------------- ------------------------------------— <br />Electricity is provided for my booth's use XQ Yes No?? <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: X Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />OXSterno & hotel trays <br /> Steam table & lids <br />X Other (specify) <br />T ’■ \ <br />I am providing food that is NOT prepared at home: Yes Q No CORRECT <br />All food is prepared on-site or is from approved commercial facilities: X Yes No <br />Name of facility: Town & Country Cate, Inc., _________Phone: —)----------------------------------- <br />Address of facility: 27 W. 10lh street Traov Ca 95376 _________________ __ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Sftvfy________ <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: