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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />i ;;Lt. <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 />1. Name of Event: Lodi wine experience <br />The following is information about my organization/business: <br />Name of organization/business: Bang in bowls <br />Address: <br /> 7100 25th ave Sacramento ca 95820 <br />Phone: ( 916 9680938 Alternate: ( ) <br />List food to be sold or given to the public: Rice bowls and loaded fries <br /> <br />4. I am providing food that is NOT prepared at home: X] Yes El No <br />All food is prepared on-site or is from approved commercial facilities: a Yes EI No <br />Name of facility: Valet indoor storage Phone: ( <br />Address of facility: 1100 'innards blvd Sacramento ca 95811 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />El 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 />51 Other (specify): Food truck <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 />X Approved bottled water. <br />El On-site hose bib that is connected to a potable water source. <br />h k There is potable water and a grey water tan on the [Si Other (specify): truck <br />Electricity is provided for my booth's use: Yes I=1 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Eg Yes El No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove El Stemo & hotel trays <br />IN Double steamer J Steam table & lids <br />[X] Electric stove top X] Other (specify) <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 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06119/19 <br />Date(s). 5/20/23