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Environmental Health Department <br />9/16/23Dale(s): I.I .Naina of Evenl: <br />The following is infornialion about my organizalion/business:2. <br />Address: <br />1 <br />3. <br />A. <br />5108944267 <br />5. <br />0 Other (speoiff): <br />Appioved waler for drinking, utensil and hand washing will be provided in my boolh by the following methods:6. <br />[✓I Approved bottled waler. <br />9. <br />meals, tamales, cooked beans, rice, <br />ll-MP EVENT APP <br />Name of organizalion/business: <br />201 N ESTES \AAY. MOUNTAIN HOUSE ,CA 95391 <br /> A boolh with walls and ceiling constructed of either wood, canvas, plastic, similar material and line 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 />Food truck A <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 />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY....... <br />( ,>f.| \ <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 />Music in the Park (September) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, Calilornia 95205 | T 209 468 3420 | F 209 464 1)138 ( www.sjgov.orgZohd <br />l-hd ig 0? Pnoo 7 o! 11 i: :.'.r:?,t::: " <br />1)6'19'19 <br />[J Sterno & hotel trays <br /> steam table & lids <br />Other (specify) Food <br />6503158979Phone; ( )Alternate; ( ) <br />Lisi food io be sold or given Io the public: MOMO AND KEBAB (Hlmalayn Food) <br /> On-site hose bib that Is connected to a polablo waler source. <br />Food Truck <br />W Ollier (specify): <br />Electricity is provided (or my booth’s uko: H Yos No <br />I am providing an accurate probo thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: |2i Yos LJ No <br />I am providing the following hot tomporaturo control for the hot holding of all potentially hazardous foods above <br />135T: <br />I 1 Camp stovo <br />LJ Double steamer <br /> Electric stove lop <br />I am providing food that is NOT prepared at home: |7| Yes No <br />All food is prepared on-site or is from appioved commercial facilities: |/J Yes H No <br />Name of facility: memo & kebab________________________pl,0,w: <br />Address of facility: 37100 Fremont Blvd, suite #k, Fremont CA 94536 _ <br />I am providing a boolh with the following; (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public)