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R EC-008 SAN JDAQUIN Environmental Health Department COUNTY ;��1 GfCptI1�55 [�fp1v5 �1Cf(' TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Music in the park 08/17/24 1. 1.Name of Event: Date(s): 2. The following is information about my organization/business: Los Primos Tex- Mex Food LLC Name of organization/business" Address: 2401 North Naglee Rd suite 100#1030 Phone: 7737081214 Alternate: 2098840191 List food to be sold or given to the public: Tacos, Burritos, Nachos, Fries, Quesadillas I 4. 1 am providing food that is NOT prepared at home: U Yes ❑ No All food is prepared on-site or is from approved commercial facilities: U Yes ❑ No Name of facility: Comisaria Modesto 2093383663 Phone: Address of facility:1211 S 7 st Modesto CA 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. U Other(specify): Food Truck Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. ❑On-site hose bib that is connected to a potable water source. Other(specify): Food trick Water system 7. Electricity is provided for my booth's use: U Yes❑ No $. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: U Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 1350F.- ❑ Camp stove ❑ Sterno& hotel trays U Double steamer ❑ Steam table& lids ❑ Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. 1868 E. Hazelton Avenue I Stockton, Calilornia 952051 T 209 468-3420 f F 209 464-0138 1 www.sjgov.org,ehd EHD 16 02 Pago 7 o1 1 1 TEMP EVENT APP 46'19/19 �— f�j