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r,xau,.v . <br />Environmental Health Department <br />1. <br />2. <br />Name of qrganization/business: <br />Address: <br />(Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />Commercial trailer 6x14 <br />6. <br />9. <br />N/A <br />meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable, water source. <br />7. <br />8. <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 wafer for drinking, utensil and hand washing will be provided in rhy booth by the following methods: <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />1. Name of Event: <br />The following is information about my organization/business: <br />The Lemon Box <br />708 Bradley Place Manteca. GA 95337 <br />510-589-6166 Alternate: ( ) - <br />Lemonade, iced coffe, aqua fressa <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 />Lodi street fair 2024 <br />.^SANJOAQUIN <br />P O l^?-’------COUNT Y------- <br />(pov.^'’’ Greclness grows liere. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Paga7of11 TEMPEVENTAPP <br />07/3/17 <br /> <br />1 am providing food that is NOT prepared at home: Yes C3 No <br />All food is prepared on-site oris from approved commercial facilities: K Yes 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 arid food preparation <br />areas from, the public. <br /> Other (specify):_—-------------------- <br />Electricity is provided for my booth’s use: 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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br />O Other (specify) <br />Date(s): 5/5/2024 <br />-