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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) <br />1.Dou Show1-Name of Event: <br />2. <br />Address:1110 Wait KnlScman Ljmo. Lodi CA 95240 <br />Phone:Alternate: () <br />3.List food to be sold or given to the public: CoBnK <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />0 On-site hose bib that is connected to a potable water source. <br /> Other (specify):___________________________________________________________ <br />Electricity is provided for my booth's use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />SAN JOAQUIN <br />— COUNTY-— <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APR <br />06/29/2023 <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 <br /> Double steamer <br /> Electric stove top <br />( 9?5 <br /> Other (specify): Coffee can <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 />) 47&9SZ8 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />the festival coordinator three (3) weeks pn^ totS C°Py °f ,hiS CheOkliS't0 <br />Date(s):. fifec <br />The following is information about my organization/business: <br />Name of organization/business: Comal Cofloo LLC <br />I am providing food that is NOT prepared at home: Q Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: ccn.»tcodec _ 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 />0 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