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1 <br />Environmental Health Department <br />i.2023 <br />Address: <br />( 209 ) 277-624SPlone: <br />3. <br />G <br />r!i I <br />top <br />i ’ lb <br />.v.'.’.v.sjcer'c com <br />Approve d water for drinking, utensil and hand washing will bo provided in my booth by the following methods: <br />. j Approved bottte'J waler. <br />The following is information about my organizatlon/buslnoss: <br />Name of organkotion/bualnoss: JJip N Fry Mobile Catering LI.C <br /> <br />SAOAOUIN <br />cot IM TV <br />'h-m i-c-*' <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) am required to return a signed and completed copy of Ihh checklist to <br />the tcstival coordinator three (3) weeke prior to this event, <br />Manteca Park-A-Palooza1 Marne of l~v<>nt: * <br />■ckten, California 95205i | T 200 468-34201 F 209 464-0138 <br />Noto: The only operations not required to provide enclosed booths are those which sell beverages 'rem <br />approved disponserr., ar prepackaged foods from approved sources <br />t-’Utefji). > r«*«_Atigusi uni, <br />. -site I ic-nbib that Is connected to a potable water source. <br />r mnnc.ify) ^clf-uontainud potable water tank. <br />"Ily it; provided (or my booth's use: 25 Yes O No —— ---------------------- <br />i ‘w ana “w holf,,n9 o' poio"ila^ <br />: 1 ""! '““““’S’ h®‘ te'Waluro conlrol far lha hoi holding of all potenllally hazardous foods rrbr,™ <br />IJ Stemo i1* hotel trays <br />Steam table lids <br />I J Other (soeclfy) <br />Alternate: ( ) <br />List food to be sold or given to the public: Hamburgers, Veggie p«Hlics, Fries. Loaded iTicr;^ Canned soda, <br />liottled water <br />I am providing food that is NOT prepared at home: £] Yes No <br />All food if. prcparco on-sito or Is from approved commercial focllltioa: PA Yus No <br />Name of facility: J -.i Coimsaria phone. (2()9 )33X-3663 <br />Address of facility. 1-1 IS. th St. Modesto, CA 95351 __ <br />i am provitiing a booth with the following: (to protect my unpackaged food and food-preparation areas from flios <br />dust and the public) <br />{J A booth with walls and ceiling constructed of eilhorwood, canvas, plastic, similar material and fine mesh fly <br />^screening, completely enclosing open food areas. It will also have a smooth and cloanablo floor (concrete <br />asphalt, clean tarps and smooth wood arc nccoptablo) and constructed to soparato food and food preparation <br />areas from the pub !c. ' <br />S Other (specify): Enclosed mobile food trailer <br />meats, tamales, cooked beans, nee, <br />-b.. examples of potentially hazardous food Include: <br />i • u' abtes, potato salad, eggs, and dairy products.