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Environmental Health Department <br />07/04/2024 Date(s): <br />1. <br />2. <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />8. <br />SANJOAQUIN <br />------COUNTY <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Fourth of July Celebration at Lodi Lake <br />All food vendors (both for profit and non-profit) are <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths are <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />LJ Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): potable water tank------- ------------------------------------------------------------------------- <br />a"d h°iding po,entia"y hazard°us <br />I a“ng9 hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer 0 Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include. <br />vegetables, potato salad, eggs, and dairy products. <br />Address: <br />Phone: ( 209 >277-6248 <br />List food to be sold or given to the public: Specialty Burgers <br />I.Name of Event: <br />The following is information about my organization/business. <br />f • »• /u iooee- Flip N Fry Mobile Catering LLC _Name of organization/business. r_____I----------------- ----------------------------- - <br />3933 Shady Oak Ct, Turlock, CA 95382 _______ ____________________ <br /> Alternate: ( )------------------------------------------- <br />• ~ . | oajgcl fries, Hot Dogs, Chicken strip s, <br />Pulled Pork, Fries, can soda, bottle water <br />I am providing food that is NOT prepared at home: Q Yes O No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes □No <br />Name of facility: La Comisaria Phone: (209 } 338^663--------------------- <br />Address of facility 1211 S. 7th St, Modesto, CA 9535J _ _ <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 /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screenina completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt cieanXs"and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Enclosed mobile food facility - trailer