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SAN JOAQUIN ! •n vi rt)i j< 11< .• 111: >I ■ 11>il i 11 I | irin h?11i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Datc(s) 4/5/251. Name of Lvent:I <br />2 <br />Address: <br />Alternate. ()...Phone <br />3. <br />4 <br />5 <br />inside booth|X) Other (specify) . <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methodsG <br />[x| Approved bottled water. <br />9 <br />n/a <br />meats, tamales, cooked beans, rice, <br />j I Sterno & hotel trays <br />[ | Steam table & lids <br />[ XX)ther (specify) <br />7. <br />8 <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 />I he following is information about my organization/business. <br />Extraordinary BlendsName of organization/business <br />15832 Wright Dr Guerneville Ca 95446 <br />| I On-site hose bib that is connected to a potable water source <br />f | A booth with 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 cleanable 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 />( 707 ). 540 2024 <br />t.ist food to be sold or given to the public: balsamic vinegars and olive oils <br />WWW Sjijov e! i! <br />ii v ' i vi m app <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 three (3) weeks prior to this event <br />. Lodi Wine Festival <br />I am providing food that is NOT prepared at home I Yes [ ) No <br />All food is prepared on-site or is from approved commercial facilities: |xi Yes | I No <br />Name of facility. The Olive Oil Factory Phone: ( 707) 426 3400 <br />Address of facility.. 770 Chadboume Rd Fairfield, Ca 94534 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />[ | Other (specify):_ <br />Electricity is provided for my booth's use: I I Yes ix| 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 [ I 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 />’ | Double steamer <br />' | Electric stove top <br />l-'h'-: I 11.iz«r'loii Avcnuo <br />I HO 16 02 <br />:)/ O'/xOi <br />Dt-.x ki.'.n C.iiilnmi.i ti'. -O'.: I I ^I ‘> .p z M <br />Pikjc / c.r ■ 1