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SAN JOAQUIN ! nvirmiiiK.'i■ lo.'ilih ! <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Cvent: J^oAodiWino Fostiva!. Oale(s): 4/5/251 <br />The following is information about my organizalion/bnsiness:2 <br />Name of organization/busincss: Tapped <br />120 N Crescent Ave, Lodi, CA, 95240Address <br />) 747-2791 Alternate ().Phone ( ?09 <br />List food to be sold or given to the public:. Chocolate Drizzled Strawberries in a cup3. <br />4. <br />!> <br />( | Other (specify).. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />I | Approved bottled waler. <br />I | On-site hose bib that is connected to a potable waler source <br />9 <br />moats, tamales, cooked beans, rice, <br />Noto: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />[ ) Sterno & hotel trays <br />1 ] Steam table X lids <br />[ | Other (specify) <br />/. <br />8 <br />|x | A booth wilh walls and coiling 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 cleanablc 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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (boll) for profit and non-profit) arc required to return a signed and completed copy of this checklist to <br />the festival coordinator throe (3) weeks prior to this event <br />I | Other (specify):. <br />filectricity is provided for my booth’s use: [ .) Yes LI No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all limes 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 />[ | Camp stove <br />[ ] Double steamer <br />[ | (Joctric stove top <br />I am providing food that is NOT prepared at home |x I Yes I I No <br />All food is prepared on-silo or is from approved commercial facilities |x] Yes [ ] No <br />Name of facility: Phone: [) <br />Address of facility:_______ <br />I am providing a booth wilh the following: (Io protect my unpackagod food and food-prcparalion areas from flies, <br />dust and the public) <br />' ll'M:»l VI N' API’ <br />I I Lizchoii Avi’iuh’; .'‘.locklcn (‘.ililnmi.i ‘l*. -{)?. | I 4(>8 .'>4?0 1 I 2\,".i 4f'4 'i: <br />I Ito 16 0? Page/of'I <br />l)Z;01.'?0?4