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Environmental Health Department TEMPORARY FOOD VENDOR’S APPLICATION the festival coordinator three (3) weeks prior to this event. 1. Name of Event:.1. 2. Name of organization/business: Casa Pinoy 355 N Guild Ave, Lodi CA 95240 Address: Phone:( 408 )772 3372 sList food to be sold or given to the public:.3. 4. 5. 6. [x] Approved bottled water. On-site hose bib that is connected to a potable water source. TEMP EVENT APP 7. 8. 9. SANJOAOUIN ------COUNTY------ 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT 07/01/2024 _____________ Alternate: ( ) BBQ, Lumpia, Pancit, Halo-halo I am providing food that is NOT prepared at home:[x] Yes O No All food is prepared on-site or is from approved commercial facilities^ Yes No Name of facility: Commissary El Gallo Phone: ( 209) 334.2573 Address of facility: 355 N Guild Ave, Lodi CA 95240 ______— I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) SJ 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. [—] Other (specify):__________________ ____________________ Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to Manteca Recreation Events 0\A ate(s): The following is information about my organization/business: Other (specify):_______________ Electricity is provided for my booth's use: Yes H No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation^ Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp st ove Sterno & hotel trays Steam table & lids Double steamer Other (specify) Electric stove top [x] Food warmer Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products.