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REC-008 ■ <br />Environmental Health Department <br />14 <br />1.1 .Name of Event: <br />Event2.The following is information about my organization,business: <br />Address: <br />773-708-1214 209-884-0191Phone:Alternate: <br />List food to be sold or given to the public: Tacos, Burritos, Fries, Nachos, Quesadillas3. <br />4. <br />5. <br />Other (specify): Food Truck <br />6. <br />9.:ontn <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />kX 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 and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <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 />Sterno & hotel trays <br />Steam table & lids <br />Other (specify) <br />No <br />neasure the hot and cold holding of potentially hazardous <br />No <br />Tor the hot holding of all potentially hazardous foods above <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APR <br />06/19/19 <br />Name of organization/business: Los Primos Tex-Mex Food LLC <br />2471 North Naglee Road Suite 100 #1030 <br />SAN JOAQUIN <br />------CtUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />| [Approved bottled water. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />Music in the F <br />I am providing food that is NOT prepared at home:| V pes| [slo <br />All food is prepared on-site or is from approved commercial facilities:| Z [/esl ^o <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 />|pn-site hose bib that is connected to a potable water source. <br />|~7~[jther (specify): Food Truck Water system <br />tlectricity is provided for my booth’s use! / [Ye; <br />I am providing an accurate probe Ihcrrrtumkter-rn: <br />foods during all times of booth operation [y'|Yes| <br />I am providing the following hot temperatui <br />_LSST: <br />)amp stove <br />Z double steamer <br />Electric stove top <br />12 <br />Date(s)u_