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SAN JOAUUIN ! nvin >t hik.‘i it -’’I ' It.'.'ilih I i' j i.’irin ics <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />4/5/2025 <br />Datc(s)I <br />2 <br />Address: <br />Phone ( <br />List food to bo sold or given to (he public3. <br />4 <br />Phone: ( <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />( | Approved bottled water. <br />[ | On-site hose bib that is connected to a potable waler source <br />9 <br />Honey is a non hazardous food <br />meats, tamales, cooked beans, rice, <br />.uo; 'I • <br />The following is informalion about my organization/business <br />Madera's Queen Honey LLCName of organization/business <br />124 Susan LN Madera CA 93638 <br />8 <br />( | Other (specify) Regular canopy, honey is prepackaged and samples are provided with <br />squeeze jars. <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 />| Sterno & hotel trays <br />( | Steam table & lids <br />[Xi Other (specify) <br />Alternate ( ) <br />Honey, honey comb, pollen, honey sticks <br />!( V > | VI N’ Al’i’ <br />I | A booth will) walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas II 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 front the public. <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 | | Yes ] No <br />All food is prepared on-site or is from approved commercial facilities: ( j Yes M No <br />Name of facility: Madera's Queen Honey LLC Phone: ( )559-377-0206 <br />Address of facility: 124 Susan LN MADERA CA.93638 <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 />I I l.i/i.,lt<:ii Avenih* <br />I I If) 16 o? <br />:)»• 01.70 21 <br />Shicl.ti-.il C.ilihHHi.)'C. I I Ziq-Hi.'. ..ITO' I <br />I ■(><;<• I <1 -1 <br />' | Other (specify) No washing required as all samples arc provided with disposable spoons <br />Electricity is provided for my booth's use: I ] Yes [X| 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 iXl No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />! | Camp stove <br />i | Double steamer <br />I | I lectric stove top <br />All food vendors (both for profit and non profit) are required to return a signed and completed copy of (his checklist to <br />the festival coordinator three (3) weeks prior to this event <br />Lodi Wine Festival1. Name of Event’. <br />j 559-377-0206