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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 09/26, 09/27 & 09/281. Name of Event: Poorba's Disco Dandiya and Durga Puja 2025 1. <br />The following is information about my organization/business: Name of2. <br />S B K Foods Inc. DBA Urban Momo <br />Address: <br />) Alternate: (( 925)523-2028Phone: <br />Momo, Chowmein, Gorkhali ChilliList food to be sold or given to the public:3. <br />4. <br />5. <br />6. <br />£3 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />the hot and cold holding of potentially hazardous <br />9. <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />organization/business: <br />2705 Stoneridge Drive, Suite B, Pleasanton, CA, 94588 <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 />SAN JOAQUIN <br />------COUNTY— <br />Greatness grows here <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 />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHD 16-02 Page 7 of 11 TEMP EVENT Al <br />06/19/19 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />[XI 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 /> Other (specify): <br />Electricity is provided for my booth's use: [X Yes O No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: |X Yes QI No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />meats, tamales, cooked beans, rice, <br />I am providing food that is NOT prepared at home: Yes Q No <br />All food is prepared on-site or is from approved commercial facilities: [X Yes Q] No <br />Name of facility: Urban Momo Phone: ( 925 )523-2028 <br />Address of facility: 2705 Stoneridge Drive, Suite B, Pleasanton, CA, 94588---------------------------------------- <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)