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i SAN JOAOUiN Environmental Health Department .. ------COUNTY-- 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. 1. 1.Name of Event; Independence Day Juneteenth Date(s). 7/4/24 6115/24 2. The following Is Information about my organizatlon/business: Name of organlzation/business: Chef Hits the Streets Address: 295 Bonner Dr mountain house 95391 510 3637616 Alternate:Phone: � ) ( ) 3. List food to be sold or given to the public: food trailer selling authentic Hawaiian pok6, acal bowls, 4. 1 am providing road that is NOT prepared at home;[0 Yes ❑ No All food Is prepared on-site or is from approved commercial facilities: W Yes ❑ No Name of facility: La comisarla Phone:t T) 2093383663 Address of facility; 1211 s 7th st Modesto ca 95351 5. I am providing a booth with the following: (to protect my unpackagod 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, '. GZ Other(specify): Food trailer i 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•sile hose bib that is connected to a potable water source, Hand wash sink with hot water Other(specify): 7. Electricity is provided for my booth's use:❑Yes W No S. I am providing an accurate probe thermometer to treasure the hot and cold holding of potentially hazardous foods during all times of booth operation:tZ 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 ❑ Double steamer ❑ Steam table&lids ❑ Electric stove top U Other(specify) Refrigeration In trailer Note: Examples of potentially hazardous food Include, meats, tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products. I 1868 E. t-lazellon Avenue I Stockton,California 95205 1 T 209 468.3420 1 F 209 464-0138 ) www.sigov.org/eh(i � EHD 10.02 Pago 7 o1 1 1 TEMP EVENT APP 06119/19 CS I