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e - <br /> f <br /> R EC-008 <br /> S A N 10 A g U I N Environmental Health Department <br /> A <br /> TEMPORARY FOOD VENDOR'S APPLICATION t <br /> All food vendors (both for profit and non-prolit) are required to return a signed and completed copy of this checkiisl to <br /> the lest,val coordinator three(3)weeks prior to this event. <br /> t. d.Name of Event. Juneteentla Dat"(s)• <br /> 2. The Vowing is inlormation about my organ izationlbusiness: _I <br /> Name of organ izatiorvbusiness: Kona Ice <br /> ii Address: 681 Saffron Drive Tracy, CA 95377 <br /> Phone: 209-597-8760 Alternate: 209-814-7680 <br /> 3. List lood to be sold or given to the public: Shaved Ice <br /> 4. 1 am providing food that,s NOT prepared at home: ✓�'csD <br /> All lood is prop ed on-site or is from approved commercial facililiesRklck <br /> Name of tarildy: On-Site Phone: <br /> Address of facility: tp <br /> 5. I am providing a booth wilh the following:(to protect my unpackaged food and food-preparaPon areas from llies P <br /> dust and the public) <br /> �4 booth with walls and ceiling constructed of either wood•canvas,plastic,similar material and fine mesh fly <br /> ,ng. completely enclosing open tood areas. 11 will also have a smooth and cleanable floor (concrele, M <br /> asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and lood preparation <br /> areas from the public <br /> her(specity): Mobile Food Truck <br /> Node: 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 /> IlDn-sile hose bib that is connected to a potable water source. <br /> &her(specify): Self Contained Water Source <br /> 7, ectncify is provided for my booth's use YebWV' No8. 1 am providing an accurate probe the sure the hot and cold holding of potentially hazardous <br /> foods during all limes of booth operation �/ o <br /> 9. 1 am providing the lollowing hot temperatu the hot holding of all potentially hazardous foods above <br /> 5'F: Q <br /> amp stove lerno&hotel trays <br /> ouble steamer team table 8 lids <br /> leGlric stove top her(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked hearts, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelinn Avenue ( Strirkton.Californm 95205 T 209 468-3420 1 F 209 464.0136 , www.slgov rxg'ehd <br /> 1710 M 02 Pagr T d 17 MM rVCNT APP <br /> Mit31s <br /> 1 <br />