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R EC-008 <br /> AN , 1 0 A Q U I N Environmental Health Department <br /> GUNTY <br /> • '•', '•' ` Grucll•nc,ss �rotvs h�rc�, <br /> fl,'r,ti . <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 throe(3)weeks prior to this event. <br /> i. 1,Name of Event Juneteenthi MIP Cultural Celebration Dato(s? 6/15/24 <br /> -L_j ,W 1/24 <br /> 2, The following Is Inlormallon about my organizatlon/buslnass: <br /> Blame of organ Izallon/business: RAYS FLAVOR OF INDIA <br /> Address: 7'1 CHARLES ST TRACY CA 95376 <br /> Phone. 408-821-6108 Alternate: 209-362-6690 <br /> 3. I.IW food to be sold or•given to the public: INDIAN STREET FOOD AND DRINKS <br /> 4. l am providing food that Is QT prepared at home: ✓�� Q5[]40 I <br /> All food Is prepared on•slle or Is from approved commercial Iao1lIIles[]ye4ZNo j <br /> Name of iaoility: Phone: <br /> Address of facility:PREPARE FOOD ON SITE <br /> 5. 1 am providing a booth with the following:(to proteoi my unpaokaged food and food-preparation areas from ilics, <br /> dust and the public) <br /> ✓ booth with walls and calling constructed of eliher wood, canvas, plastic, similar rnaterfal and fine mesh fly <br /> entng, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean carps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from(he public. <br /> Dther(speolly):.,,.,, _ <br /> Note: The only operations not required to provide enclosed booths aria those which sell bevoragcs from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utonsll and hand washing will be provided In my booth by the following methods; <br /> ✓Approved battled water. <br /> i <br /> Dn-stto hose bib that Is oonnecled to a potable water source, j <br /> iher(specify): <br /> 7. PecArloHy Is provided Ior nay booth's ust�yj <br /> &/ No <br /> 6, 1 am providing an aocurafe probe theasure the hot and cold holding of potentially hazardous <br /> foods during all times of booth opera o <br /> 0. 1 am prooviding the following'hot tempe the hot holding of all potentially hazardous foods above <br /> a <br /> 50 r: <br /> amp stove Stero& hotel trays <br /> ouble steamer Stearn table&lids <br /> locirle stove top Other(speo€4y) <br /> Note: t*xanipios of potentially hazardous food Include: meaty, 1',mules, cooked beans, rice, <br /> vegetubles,potato salad,eggs,and dairy products. <br /> 1868 E. Hazellon Avenue I Stockton,California 95205 I T 209 466-3420 I F 203 464.0138 1 www.slgov.org/ehd <br /> Mr, M.N. Pogo7of 11 TRAP FWNTAPP <br /> a6r1w19 <br />