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I <br />Environmental Health Department <br />Date(s)' 09/20/2024i.Nyne of Event: Hispanic Heritage i. <br />2. <br />Adttcss: <br />773-708-1214 209-884-0191Phono;Alternate: <br />ust food io be sow or given to the poaic: Tacos, Burritos, Fries, Nachos, Quesadillas3, <br />4 <br />5 <br />6 <br />9. <br />meats, tamales, cooked beans, rice. <br />J <br />l\UV~UUU a <br />Note: The only operations not required to provide enclosed booths are those which sefl beverages from <br />approved dispensers. or prepackaged foods from approved sources. <br />Stcrno & hotel trays <br />Steam tabic & l»ds <br />Dlhcr (specify) <br />7. <br />8 <br />SAN JOAQUIN <br />-----COU NTV------ <br />G.’cotrcn $ro*i here. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Approved waler for drinking, uicnsi and hand washing will be provided In my booth by the following methods: <br />| ^Approved tx>tllcd waler <br />I ^n-site hose bib that is connected to a potable water source. <br />[✓})thcr (specify): Food Truck Water system <br />tlcctrlcity Is provided for my booth's usef^ Yci <br />I am providing an accurate probe themteenhtor <br />foods during al limos of booth operation(✓[V <br />I am providing the foilowing hot temperature controTTor the hot holding ol all potentially hazardous loods above <br />Damp stove <br />✓ Double steamer <br />jEIcctrlc stove top <br />Note: Examples ol potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />Al food vendors (boti lor profit and non-profit) are required to return a signed and compielcd copy ol tes checklist io <br />the losVval coordinator three (31 weeks oner to ihls event. <br />I am providing food that is NOT prepared al home:[l/pcs| [fo <br />Alt food Is prepared on-sllc or is from approved commercial facilitiesjt/p'csl ^Jo <br />Name ol laclity: Commissa7 Modesto ^0; 209-362-9123 <br />Address of faatlty: 1211 S 7th Street <br />I am prowling a booth with the foilowng: (to protect my unpackagcd food and lood-preparatton areas from Illes, <br />dust and the public) <br />No <br />neasurc the hot and cold holding ol potentialy hazardous <br />No <br />1868 E. Hazelton Avenue | Stockton. CaMorma 95205 | T 209 468-3-1201 F 209 464-0138 | www s(gov ora'chd <br />EHDlS-aZ PrjrZolii TCVP EVENT x#? <br />B'lJ 19 <br />j p booth with walls and colling constructed ol cither wood, canvas, plastic, similar matenal and tine mosh fly <br />OTocning. completely enclosing open food areas. Il will also have a smooth and cteanabte floor (concrete, <br />asphalt, clean tarps and smoofi wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />{✓father (specify): Food Truck <br />The following is information about my organlzattocbuslncss: <br />Name of organization-business: iOS Primos Tex-Mex Food LLC <br />2471 North Naglee Road Suite 100 #1030