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Environmental Health Department <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />- C OU NTV —.. <br />And sodas. <br />Io <br />) 209-369-2771 <br />EHD I02 Hazelton Avonue 1 Stockton, California 95205 I T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehct <br />06/29/2023 Pa9e 7 °f 11 TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the ™ ^unitred ,0 retum a sisned and completed copy of this checklist to <br />1- 1N--f^nt:LodidoashOW-----------------------------------------Date(s):W <br />The following is information about my organization/business: <br />Name of organization/business: Original Soft TaCO LLC <br />Mdress: _533g_SLChgrry Ave ~~ Fresno, CA 93706~ ~~ <br />( )55g2§30-5445 Alternate: ( ) 209-774-6301 <br />List food to be sold or given to the public: Hot dogs, hamburgers, breakfast burritos, chips, <br />I am providing food that is NOT prepared at home: Q Yes No <br />All food is prepared on-site oris from approved commercial facilities: K YesTj n' <br />Name of facility: Lodi Grape Festival kitchen Phone. <br />Address of facility.-^ 13 E. Lockeford St. Lodi, CA. 95240 ne’ <br />dusPt and the public)1 fO,,Owin9: (to protect mV unpackaged food and food-preparation areas from flies, <br />areas from the public. P d constructed to separate food and food preparation <br />Ki other (specify): Lodi Grape Festival Kitchen <br />Not6: - — - <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />13 other (specify):Kitchen sinks <br />Electricity is provided for my booth’s use: Yes No ----------------------------------------------- <br />' h°' PO'entiaily hazardous <br />1 an Pop V,ding the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sterno & hotel trays <br />KI Double steamer Q Steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.