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Docusign Envelope ID: 6FF94AB9-B198-4039-850D-3AF42A648rAA <br />SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />LODI BEER FESTI.Namc of Event:1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6.Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods: <br /> Approved bottled water. <br />(xl On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />IxJ 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 <br />areas from the public. <br />Note: 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 />The following is information about my organization/business: <br />Young's family bbq <br />1868 E. Hazelton Avonue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVEN TAPP <br />07/3/17 <br />5309334923 <br />( ) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Name of organization/business: <br />1508 holly tree dr yuba city ca 95993 <br />Fl Other (specify): <br />Electricity is provided for my booth s use: I Yes 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: E3 Yes LJ No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />bd Camp stove <br />LJ Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: Gel Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes U No <br />Name of facility: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 />Date(s): APRIL 26.2025 <br />LJ Sterno & hotel trays <br />I I Steam table & lids <br /> Other (specify) Bbcl gri11 and 2 burner stove <br />Alternate: ( ) <br />Bratwurst sausage pulled pork <br />List food to be sold or given to the public:____________