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Environmental Health Department <br />1.1.Name of Event: TYSL Date(s): 8/19/23-11/14/23 <br />2.The following is information about my organization/business: JAY’S GOURMET LLC <br />Name of organization/business: JAY’S GOURMET LLC <br />3. <br />4. <br />5. <br />X Other (specify): CONCRETE SNACK BAR <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />X Approved bottled water. <br />X On-site hose bib that is connected to a potable water source. <br />9. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from approved <br />dispensers, or prepackaged foods from approved sources. <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, asphalt, <br />clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from <br />the public. <br />Sterno & hotel trays <br />Steam table & lids <br />Other (specify) <br />7. <br />8. <br />I am providing food that is NOT prepared at home: X Yes No <br />All food is prepared on-site or is from approved commercial facilities: X Yes No <br />Name of facility: LEGACY FIELDS Phone: (209) 831-4222 <br />Address of facility: 2300 N. TRACY BLVD, TRACY, 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 />List food to be sold or given to the public: HAMBURGERS, HOT DOGS, NACHOS, FRENCH FRIES, CANDY, <br />WATERS, SODA ------------------------------------------------------------------------------------------------ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 13 TEMP EVENT APP <br />06/19/19 <br />Address: 95 W. 11™ STREET STE 201 TRACY, CA. 95376 <br />Phone:(209) 399-0888_Alternate: (510) 385-0272 I (925) 967-3809 <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 />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, <br />potato salad, eggs, and dairy products. <br />Other (specify): <br />Electricity is provided for my booth’s use: X 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 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />X Camp stove <br />Double steamer <br />X Electric stove top <br />SAN JOAQUIN <br />------COUNTY— <br />'SltjpopjJz' Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION