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r.rgi <3 <br />SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event1. <br />2. <br />Address <br />624-6588Phone.) ( 408 ) <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />E3 Approved bottled water <br />Q On-site hose bib that is connected to a potable water source <br />9 <br />A- <br />7. <br />8. <br />The following is information about my organization/business: <br />■ - - Butler Amusements- J&L Sweeties <br />Noto: 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 />_______________ Alternate: ( <br />See Attached Form <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 />Lodi Grape Festival <br />Name of organization/business: -------------------------------- — <br />15260 Bryson Ct Morgan Hill, CA 95037 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation (3 Yes No <br />I am providing the following hot temperature control for the hot holding cf all potentially hazardous foods above <br />135T. <br /> Camp stove <br />F] Double steamer <br />n Electric stove top <br />Datefs;. 9/11-9/14 2025 <br />1868 E Hazelton Avenue | Stockton. California 95205 [ T 209 4 68-3420 F 2094’-i.; i V: ; wv.w <br />f HD *.602 Pa;e7o<11 <br />0Z <br />[ 1 Other (specify) <br />Electricity is provided for my booth's use: L3 Yes No <br />I arn providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />I am providing food that is NOT prepared at home: H Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes O No <br />Name of facility:Phone: ( I <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 />meats, tamales, cooked beans, rice, <br />Q Sterne & hotel trays <br /> Steam table & lids <br /> Other (specify) Heat lamps, food warmers, crock-pot <br />Q 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 />Q Other (specify): Enclosed food trailer