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Environmental Health DepartmentSAN JOAQUIN TEMPORARY FOOD VENDOR’S APPLICATION 1 Name of Event:1 2 Address: Phone: List food to be sold or given to the public:3 4 5 those which sell beverages from 6 0 Approved bottled water On-site hose bib that is connected to a potable water source 9 meats, tamales, cooked beans, rice, 3i -i -..'5 T 2' Page 7 oil 1 7 8 EHD 16-02 07'01'202'1 The following is information about my organization/business Name of organization/business: Casa Pinoy-------------------------- 15932 Crescnet Park Cir, Lathrop CA 95330 ,j:- j.s-ci TEMP EVENT APR unpackaged food and food-preparation areas from flies. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Red, White & Brew Wine & Beerfest ______________Alternate: ( )_ BBQ, Lumpia, Noodles, Crispy Pork, Beef salpicao Date(s) 3/29/2025 Other (specify):________________ Note: The only operations not required to provide enclosed booths are 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: I am providing food that is NOT prepared at home: 0 Yes No All food is prepared on-site or is from approved commercial facilities: 0 Yes EJ No Name of facility Commissary El Gallo Phone: (-------1 Address of facility 355 N. Guild Ave, Lodi CA I am providing a booth with the following: (to protect my dust and the public) 0 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 (concree, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify)---------------------------------------------------------------------------------------------------------------------------- Electricity is provided for my booth’s use □Yes0No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially Hazardous foods during all times of booth operation: 0 Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135’F: Camp stove C Sterno & hotel trays 0 Double steamer 0 Steam table & lids Electric stove top Other (specify) (408)) 7723372