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Docusign Envelope ID. 94735839-877B-4'139-B749-O81B9A1E9498 <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 />Food Truck[x] Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <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 /> 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 are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />The following is information about my organization/business: <br />Park’s Barks BBQ <br />Name of organization/business: <br />613 s lee ave Lodi, Ca 95240 <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www sjcehd.com <br />Elio 16-02 Pago7of11 TEMP EVENT APP <br />07/3/17 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />. I Other (specify):___________________________________________________________ <br />Electricity is provided for my booth’s use: R 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: Lxl Yes F l No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />U Camp stove <br />LI Double steamer <br /> Electric stove top <br />Sam’s custom cakes and catering 209 327 1389 <br />(Rio vistaJ_CA_+l^_£70Zl_5Q7r2345_______Alternate: ( ) <br />Brisket, ribs, chicken, pork, beans, coleslaw, macaroni and <br />List food to be sold or given to the public: cheese, macaroni salad specials, <br />U Sterno & hotel trays <br />lxl Steam table & lids <br />[x] Other (specify) Hot *30X <br />Date(s):APRIL 26.20?5 <br />I am providing food that is NOT prepared at home: LI Yes LI No <br />All food is prepared on-site or is from approved commercial facilities: Yes U No <br />Name of facility: See Above 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)