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CC)U TY �� �r✓f . <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> bod vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> festival coordinator three (3)weeks prior to this event. <br /> 1.Name of Event: <br /> Lodi Street Faire Date(s) 05/04/2025 <br /> : <br /> 10/bpS7 <br /> The following is information about my organization/business: <br /> Queen Bs Herbal Teas and More <br /> Name of organization/business: <br /> Address: 9321 Pioneer Circle, Stockton CA. 95212 <br /> Phone: 8Q0 ) <br /> 523-1905 Alternate: (209 2-21-5088 <br /> ( } <br /> List food to be sold or given to the public: Pre-packaged Herbal Tea Blends <br /> I am providing food that is NOT prepared at home: ❑ Yes ©(No <br /> All food is prepared on-site or is from approved commercial facilities: ❑ Yes ❑x No <br /> Name of facility: Phone: ( ) <br /> Address of facility: <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 /> ® Other (specify): pre-packaged food booth <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 /> ❑ Approved bottled water. <br /> ❑ Orr-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): n/a <br /> Electricity is provided for my booth's use: ❑ Yes U 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: ❑ 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 /> ❑ Camp stove ❑ Sterno & hotel trays <br /> ❑ Double steamer ❑ Steam table & lids <br /> ❑ Electric stove top ❑ Other (specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products, <br />