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. 'i <br />Environmental Health Department <br />Datefs): 4/13-17/23I.Name of Event: 1. <br />2. <br />Address: <br />)(Phone: <br />List food to be sold or given to the public:3. <br />4. <br />) 209-369-2771 <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br />The following is information about my organization/business: <br />Original Soft Taco LLC <br />Gas kitchen stoves <br />meats, tamales, cooked beans, rice, <br />SAN JOAQUIN <br />------COUNTY------- <br />Gtncf:5 tjrorvi <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov org/ehd <br />EHD 16-02 Page 7 of 11 <br />06/19/19 <br /> Other (specify): <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Name of organization/business: <br />5339 S. Cherry Ave_____ __ <br />559-630-5445/209-774-630lAiternate: ( ) <br />Burritos, hamburger,hot dogs, chips, pastry, beverages <br /> On-site hose bib that is connected to a potable water source. <br />K other (specify): Full kitchen facility ___________________________ <br />Electricity is provided for my booth’s use: £3 Yes 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: [3 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />LJ Camp stove ED Stemo & hotel trays <br /> Double steamer D Steam table & lids <br /> Electric stove top KJ Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: £3 Yes ED No <br />All food is prepared on-site or is from approved commercial facilities: 03 Yes ED No <br />Name of facility: Lodi Grape & Harvest Festival Phone-. ( <br />Address of facility: 413 Lockeford St. Lodi Lodi,CA 95240------- <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 /> 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 />Commisary kitchen