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S A N J O A Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food verdDrs •;both for pfofit and non-profo are rewired to return a signed and completed copy of this checklist to <br /> the festival coordinator three 131,-weeks prior to this event_ <br /> t_ ?.Name of Event Taste of Soul Dates): September 7 & 8, 2024 <br /> The following is mtormabon about my organaauonuhusiness: <br /> Name of organ izationbusiness: Chef D°s Cajun Foods <br /> Address: 355 S Grand Ave#2450 Los Angeles. CA%071 <br /> Phone: I g51 ) 552-5003 Alternate. <br /> 3- List food to be sold or given So the pubbc_ Fish. Shrimp, Bator. Frog.jarnbalaya <br /> 4. 1 am providing food that is NOT prepared at home: ® Yes ❑No <br /> All food is prepared on-site or G frcr,approved commercial facilities. jZ Yes ❑No <br /> Name crl faality: all food prepared on-site Phone 1 <br /> Address of faolrty: <br /> 5_ 1 am providing a booth with the following:(to protect my unpackagec tocd anc f,xA-preparation areas from flies. <br /> dust,and the publw I <br /> ® A booth with watts aric ceiling constructed of either wood. canvas. plastic. similar material and fine rnesh fl.i <br /> screening. completely enclosing oper, food areas. it will also have a smooth arid cleanable floor f con-_rete. <br /> asphalt. clean tarps and smooth woos are acceptable) anc constructed to separate food and food preraraticn <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 /> Qf Approved bottled water.. <br /> ❑On-site nose bib that is connected to a :,,,table water sauce. <br /> ®Other(sWify;I bringing potable water <br /> t_ Electricity is provided for my booth's use: h6 Yes No <br /> I am providing an accurate probe thermometer to measure the hot anc cold holding of potentially hazardous <br /> foods during all times ct bcolh oceration: 0 Yes❑ No <br /> 9 1 am --r-avicing the i l000ng hot temperature control for the hot holding of all pctennall•y hazardous foods stY ve <br /> 135'"F <br /> ❑Lamp.s ,ve ❑.S.remo&hotel trays <br /> ❑ Doutale shame- ❑Stearn ta:,le&lids <br /> ❑ Electric sio.=-Ip ®O'cher Isper-dy:- <br /> tri_dl <br /> Note: Examples of potentially hazardous food include: meats. tamales. cooked beans, nce. <br /> vegetables. potato salad. eggs.and dairy products.. <br /> 1868 E. Hazetton Avenue I StocicWk.CaVornia 952061 T 209 468-34201 F 209 46 -0138 1 ww,►r.slgov.orq'ehd <br /> EHO 16-02 Ppa 7 d 11 TEMP EVENT APP <br /> 067L'2023 <br />