Laserfiche WebLink
SAN -JOAQUIN Environmental Health Department <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.NameofEvent: Red white and brew Date(s): <br /> 3/Z9/2025 <br /> 2. The following Is information about my organizationlbusiness: <br /> Name of organizationlbusir"f hi is the streets <br /> Address <br /> 295 Bonner drive Mountain house ca 95391 <br /> Phone: ) 510-363-7616 Alternate: ( ) <br /> 3. List food to be sold or given to the public:Hawaiian poke and acai <br /> 4. 1 am providing food that is NOT prepared at home:[1 Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities]Yes❑No <br /> Name of facilityllax'5 Kitchen utc PhoneZV-33q-3663 <br /> Address of facility: modesto CA <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 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 /> ❑)Qther(specify): Permitted food truck in san jaoquin <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 /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ® Other(specify):H and wash sink in food truck <br /> 7 Electricity is provided for my booth's use: ❑Yes[3 No <br /> & 1 am providing an accurate probe thermo ter 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 /> 135"F: <br /> ❑ Camp stove ❑ Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑ Other(specify) only cold food and rice warmer <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> U4 '6 a2 'age 7 or 11 r <br /> cfir2912023 <br />