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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Manteca Recreation Events Date(s): 1. Name of Event:1. <br />The following is information about my organization/business:2. <br />Name of organization/business: Casa Pinoy <br />355 N Guild Ave, Lodi CA 95240Address: <br />Phone:(408 )772 3372 <br />List food to be sold or given to the public:.3. <br />4. <br />5. <br />6. <br />[x] Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />TEMP EVENT APP <br />7. <br />8. <br />9. <br /> Stemo & hotel trays Steam table & lids <br />O Other (specify) <br />[x] Food warmer <br />SANJOAOUIN <br />------C OUNT Y------ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www.sjgov.org/ehd <br />1 „ _ , .. Trim rucuTEHD 16-02 Page 7 of 11 —-------- <br />07/01/2024 <br />_____________ Alternate: ( ) <br />BBQ, Lumpia, Pancit, Halo-halo <br />I am providing food that is NOT prepared at home® Yes No <br />All food is prepared on-site or is from approved commercial facilities^] Yes O No <br />Name of facility: Commissary El Gallo Phone: ( 209) 334.2573 <br />Address of facility: 355 N Guild Ave, Lodi CA 95240 _ <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) <br />E A/rooth 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 />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 /> Other (specify): <br />Electricity is provided for my booth’s use: Yes El No <br />I 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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp st ove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <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 />L .kA Mp3