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Phone: 773-708-1214 Alternate: 209-884-0191 <br />DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />SAN JOAQUIN <br />—COUNTY — , <br />\1,C fp VAT; Greatness grow!, <br />REC-008 <br />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 />4th of July <br />1.Name of Event: Date(s): <br />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 /> <br />4144- <br />List food to be sold or given to the public: Tacos, Burritos, Fries, Nachos, Quesadillas <br />I am providing food that is NOT prepared at home: 1 l'es Jo <br />All food is prepared on-site or is from approved commercial facilities0Yesalo <br />Name of facility: Commissary Modesto Phone: 209-362-9123 <br />Address of facility:1211 S 7th Street <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />ok 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 an sru ooth wood are acceptable) and constructed to separate food and food preparation <br />as from the pu ic. <br />Food Truck 3- S— Co <br /> tier (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 the following methods: <br />FlApproved bottled water. <br />Fljn-site hose bib that is connected to a potable water source. <br />ther (specify): Food Truck Water s stem <br />ectricity is provided for my booth's use ,./ IYe. No <br />I am providing an accurate probe thermv r-rczcaeasure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation 1 Yes No <br />I am providing the following hot temperature7ontro-1T the hot holding of all potentially hazardous foods above <br />q5°F: <br />amp stove <br />ouble steamer <br />lectric stove top <br /> <br />Sterno & hotel trays <br />Steam table & lids <br />Other (specify) <br /> <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-34201 F 209 464-0138 www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06119119