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Environmental Health Department <br />are required to return a signed and completed copy of this checklist to <br />1. <br />Date(s): 9/1/23 THROUGH 10/31/23 <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br /> 3 <br />7. <br />8. <br />eh8d6?6-o2 Hazelton Avenue 1 Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06/29/2023 Pa9e 7 of 11 TEMP EVENT APP <br />SAN,JOAQUIN <br />------COU NTY------- <br />Greotness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) ’ <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: TRACY LITTLE LEAGUE - SNACK BAR (FALL BALL) <br />The following is information about my organization/business: <br />Name of organization/business: TRACY LITTLE LEAGUE <br />Address: LEGACY FIELDS-4901 N. TRACY BLVD., TRACY,CA 95304 <br />< 510 ) .S95-7366----------- ---- Alternate: ( 925 ) 413-7897 <br />List food to be sold or given to the public: Nachos, pizza, hot dogs, chips, popcorn, soda, water <br />candy, sports drinks. ————— <br />I am providing food that is NOT prepared at home: E Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: LEGACY FIELDS Phone:(510)695-7366 <br />Address of facility: 4901 N. Tracy Blvd., Tracy CA 95304 <br />' TuSthe PS)" W#h lt° P “ unpacka9ed f°°d a"d tod-preparation areas from flies, <br />EraAenb,°n00,h/±n2, “"ST**1 of either wood, canvas, plastic, similar material and fine mesh fly <br />S N completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete7 <br />areas>fromthepublic acceptable) and instructed 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 /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: E Yes No <br />' pro.vldin9 a" accurato probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No y "drdluous <br />' pr°viding the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top £] other (specify)Grill <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.