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R EC-008 <br /> ,3i.;7u,y <br /> 4' SAN 10AQUIN Environmental Health Department <br /> C4VUNTY <br /> Greot17C'55 Crow here. <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 /> Kite Festival 6/112024 <br /> 1. 1.Name of Event: Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: Los Primos Tex-Mex Food LLC <br /> Address_ 2471 North Naglee Road Suite 100 #1030 <br /> Phone_ 773-708-1214 Alternate: 209-884-0191 <br /> I List food to be sold or given to the public: Tacos, Burritos, Fries, Nachos, Quesadillas <br /> 4. 1 am providing food that is NOT prepared at home: ✓]YOSD to <br /> All food is prepared on-site or is from approved commercial facilities: ✓lYes[:]No <br /> Nameoffacilily: Commissary Modesto _Phone: 209-362-9123 <br /> Address of facility:1211 S 7th Street <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 /> booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and tine mesh fly <br /> ening, completely enclosing open food areas. 11 will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean larps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> ✓�ther(specify)_ Food Truck <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 /> [:]7n-site hose bib that is connected to a potable water source, <br /> 5dricilly <br /> her(specify): Food Truck Waters stem <br /> 7. is provided for my booth's use 1/ Ye No <br /> B. 1 am providing an accurate probe the asure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation ✓ Ye o <br /> 9. 1 am providing the following hot temperatu ntr the hot holding of all potentially hazardous foods above <br /> q5OF: <br /> amp stove Stero& hotel trays <br /> ouble steamer Stearn table &lids <br /> lectric stove top Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazellon Avenue I Stockton, California 952051 T 209 468-3420 { F 209 464-0138 1 www.sigov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> DS 19119 <br />