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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />1.12/07/2024Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />the hot and cold holding of potentially hazardous <br />all potentially hazardous foods above <br />www.sjgov.org/ehd <br />TEMP EVENT APR <br />7. <br />8. <br />SAN JOAQUIN <br />...COUNTY <br />The following is information about my organization/business: <br />Name of organization/business: Onigurus LLC <br />1778 Wellington Ave, Manteca CA 95337 <br />(408 ) 476-2922 <br />List food to be sold or given to the public: <br />eX-02 HaZelton Avenue I Stockton, California 95205 | T 209 468-3420, F 209 464-0138 | <br />06/29/2023 Page 7 of 11 <br />All food vendors (both for profit and non-profit) are i <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Christmas in the Park 2024 <br />)__________Alternate: ( <br />Fusion Onigiri <br />I am providing food that is NOT prepared at home: SKVes No <br />All food is prepared on-site or is from approved commercial facilities: H'Ves No <br />Name of facility: __Tealite Modesto Phone; (408)802-0258 <br />Address of facility: 3848 McHenry Ave #120 Modesto, CA 95356 <br />' tond me puMoj lh<i ,O"°Wl,,9: (,° ,’ro,eC, and food-preparation areas from flies,' <br /> Other (specify):___________ <br />NOte: -hose se. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />K^pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />CJ Other (specify): <br />Electricity is provided for my booth’s use: SA'es Q No <br />I am providing an accurate probe thermometer to measure <br />roods during all times of booth operation: O Yes O No <br />1 ar^ Provdmg the following hot temperature control for the hot holding of <br /> Camp stove Q Sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top Sather (specify) Countertop Heated Display Case <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.