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F SQN.JQQQQIN Environmental Health Department <br /> ----COUNT.', <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 W glLVU Y\,\4,AA>^ ,S)Ct{Q,�- "olif Date(s) <br /> 2 The following is information about my organization/business <br /> Name of organization/business. Pitayas LOcas <br /> Address 1211 S. 7th street Modesto CA 95351 <br /> Phone ( 209) 289-3243 Alternate ( ) <br /> 3. List food to be sold or given to the public: Aguas Frescas, Fruit cups, smoothie bowls. cord <br /> 4 1 am providing food that is NOT prepared at home. Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities:W Yes❑ No <br /> Name of facility: Le Comisaria Modesto Phone: (209) 338-36 33 <br /> Address of facility. 1211 S 7th Street Modesto 95351 <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 /> �A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal 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 /> �f Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source <br /> ❑Other(specify): <br /> 7 Electncity is provided for my booth's use: ❑ Yes❑ 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: ❑Yes❑ No <br /> 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F <br /> ❑Camp stove ❑ Stemo&hotel trays <br /> ❑ Double steamer ❑ Steam table& lids <br /> ❑ Electric stove top DQ Other(specify)(JZ �kq t T^O S <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 186E E Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sigov orglehd <br /> EHD 1"2 Page 7 of 11 TEMP EVENT APP <br /> 09/29/2023 <br />