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It . <br />REC-008 <br />, SA1GOAQUIN <br />—COUNTY— <br />.' Grootrum rov h (:re, <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Environmental Health Department <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 /> <br />1. 1,Name of Event <br />Juneteerath MIP Cultural Celebration Date(s 6/15/24 <br />4-J <br /> <br />2, The following is Information about my organization/business: <br />Name of organization/business: RAYS FLAVOR OF INDIA <br />Address: 71 CHARLES ST TRACY CA 95376 <br />3, List food to be sold or given to lho Public: INDIAN STREET FOOD AND DRINKS <br />4. I am providing food that Is NOT prepared at home: es \lo <br />All food is prepared on-site or is from approved commercial facilities: e <br />Name of facility: Phone: <br />Address of facIlity:,PREPARE FOOD ON SITE <br />S. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from Illes, <br />dust and the public) <br />4Abooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />ening, 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 />riDther (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 />6. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />[]Approved bottled water, <br />rlDn-site hose bib that is connected to a potable water source. <br />Pther (specify): _ <br />ectricity Is provided for my booth's use Y <br />I am providing an accurate probe ther <br />foods during all times of booth operation <br />0. I am providing the following'hot temperatu <br />q5°F: <br />damp stove <br />ouble steamer <br />fectric stove top <br /> <br />Sterno & hotel trays <br />Steam table & lids <br />Other (specify) <br /> <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazel Ion Avenue I Stockton, Oalifornle 95205 I T 209 468-3420 I F 200 464-0138 I www.sigov.org/ehd <br />EHD 16.02 Page7of II TEMP EVENT APP <br />08/9/18 <br />Al ternate: 209-362-6690 <br />t/ No <br />r-uziqasuro the hot and cold holding of potentially hazardous <br />Yes No <br />ntrot to the hot holding of ell potentially hazardous foods above <br />Phone: 408-821-6108