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DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />R EC-008 <br />SAN.AAQUIN • _-COUNTY- <br />' Grecaness vows h ere, <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Environmental Health Department <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 Juneteenth 5/18,511,5/15,7/4,7/20 <br />1.Name of Event: <br />Music In the Par— July 4 July 2D0ate(s), <br />The following is information about my organization/business: <br />Name of organization/business: Shish Grill <br />Address: 1061 Market Place San Ramon CA <br />Phone: +1 (925)-415-3270 Alternate: <br /> <br />List food to be sold or given to the public: Chicken Shawarma wrap, Falafel, Gyro, Fries, & Lamb Burger <br />I am providing food that Is NOT prepared at home: <br />All food is prepared on-site or is from approved commercial Willies: <br />Name of facility: Shish Grill Phone: <br />Address of facility.1Q51_Markol_p_lao_San_jaamQD_QA___ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files, <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />s ening, 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 />rThther (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 />Approved water for drinking, utensil and hand washing will be provided In my booth by tho following methods: <br />FlApproved bottled water. <br />rThri-site hose bib that Is connected to a potable water source. <br />Pther (specify): <br />YeE No eotrIcIty Is provided for my booth's use <br />I am providing an accurate probe therrrv asure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation Yes <br />I am providing the following hot temperatu the hot holding of all potentially hazardous foods above 7-0-ontrof fo <br />115°F: <br />,lamp stove <br />ouble steamer <br />lectric stove top <br />Stern° & hotel trays <br />Steam table & lids <br />Other (specify) <br />Note: Examples of potentially hazardous food include: meals, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E, Hazeiton Avenue I Stockton, California 95205 I T 209 468-3420 F 209 46,1-0138 I www,sjgov.org/ehd <br />Elio 16.02 7of 11 MAP EVENT APP <br />05/19119