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Docusign Envelope ID: B7B2DD28-1DFC-410A-9GED-83CBA3B73872 <br />SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />LODI BEER FESTI.Name 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 be provided in my booth by the following methods: <br />[ ] Approved bottled water. <br />[x] On-site hose bib that is connected to a potable water source. <br />9. <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <br />(xl 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 />BELLA BBQ <br />Name of organization/business:________________ <br />10239 Nations Circle Stockton CA, 95209 <br />209-992-9348 <br />( ) <br />1868 I'. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />El ID 16-02 Pago 7 of 11 TEMP EVEN 1 APP <br />07/3/17 <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 />Alternate: ( ) <br />ribs, pulled pork, nachos, tri tip <br />List food to be sold or given to the public: <br />1 Other (specify): <br />Electricity is provided for my booth's use: Q 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: l.x] Yes ED No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />I Camp stove <br />LJ Double steamer <br />EJ Electric stove top <br />LJ Sterno & hotel trays <br />l*J Steam table & lids <br />[x] Other (specify) warming cabinet <br />Date(s);APR!L2<^ <br />I am providing food that is NOT prepared at home: EJ Yes No <br />All food is prepared on-site or is from approved commercial facilities: bd Yes LJ 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)