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SAN.-JOAQUIN Environmental Health Department <br /> —COUNTY----... <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 /> 1, 1.Name of Event: Ripon Main Street Day oate(s): 10/19/24 <br /> 2. The following is information about my organization/busines& <br /> Hyderabadi Eatz <br /> Name of organ izationlbusiness: <br /> Address: 16569 E Higway 120 . Ripon , CA 95366 <br /> Phone: e25 )694-2959 Alternate: e09 )924-7813 <br /> 3, List food to be sold or given to the public: Samosa, Chicken 65 , Pakora, Chicken Paneer Lamb Shawarma, Rice&Butter <br /> cooler <br /> 4, 1 am providing food that is NOT prepared at home: ®Yes D No <br /> All food is prepared on-site or is from approved commercial facilities: ❑x Yes❑ No <br /> Name of facility: Hyderabadi Eatz `Phone: 025 )694-2959 <br /> Address of facility:16569E Highway 120 Ripon. CA, 95366 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> 0 A booth with wails 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 /> 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 /> N Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> Other(specify): <br /> 7. Electricity is provided for my booth's use: Yes D No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: M Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'Fl. <br /> ®Camp stove ❑Sterno&hotel trays <br /> ❑ Double steamer ®Steam table&lids <br /> ❑Electric stove top X Other(specify) Kettle Cooker <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> 1868 E. Hazelton Avenue l Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 I www.sjcehd.com <br /> EHD 1642 Page 7 of 11 TEMP EVENT APP <br /> 0713117 <br /> Text <br />