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i t11( <br /> + -"'• }1.. (� ;�0 A Q u Environmental Health Department <br /> P`" '!: COUNTY <br /> `:+.+nrt'��' �T1r'tll77c+1S ifrUYlS JK'Jt•. <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 three(3)weeks prior to this event. <br /> Manteca Pumpkin Fair 10/1/22 & 10/2/22 <br /> 1. 1.Name of Event: Date(s): <br /> 2. The following is information about my organizationibusiness: <br /> Name of organization/business: Fagundes Street BBQ LLC <br /> Address: 142 Jason St, Manteca, CA 95336 <br /> Phone: ( 209 ) 275-0561 Alternate: ( ) <br /> 3. List food to be sold or given to the public: Cheese Pizza, Pepperoni Pizza, Hawaiian Pizza, Pork Belly Pizza <br /> 4. 1 am providing food that is NOT prepared at home: MYes ❑No <br /> All food is prepared on-site or is from approved commercial facilities: 9Yes❑No <br /> Name of facility: Fagundes Meats and Catering phone:(209) 239-4184 <br /> Address of facility: 142 Jason St, Manteca, CA 95336 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A 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 /> 9Other(specify): We are a fully built and self contained food pizza kitchen. <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 /> 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> El Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> &Z Other(specify): We have our own self contained internal water source. <br /> 7. Electricity is provided for my booth's use: 0 Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:P1 Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑ Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top S�Other(specify) 500-800 degree pizza oven <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 i F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06/19119 <br />