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Environmental Health Department <br />1. Name of Event:1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />I I MP I-VEN I API’ <br />□ Other (specify):_ — <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />7. <br />8. <br />SANJOAOUIN <br />7------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Iw | <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and daily 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 />LODI GRAPE FESTIVAL <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcelid.com <br />I in) ic, 02 I’arjej 7of 11 1: : <br />07/3/17 <br />Date(S): SEP 11-14,2025 <br />'■■U/FOV'''' <br />) 3Oi ____ <br />List food to be sold or given to the public:-Q t i-. <br />The following is information about my organization/business: <br />Name of organization/business: x 7 <br />Address: ^70 __AjJZA- --—■——————-y <br />Alternate: <br /> \( V <br />1 <br />I am providing food that is NOT prepared at home: Sji Yes No <br />All food is prepdredomsite^r is from approved commercial facilities:QYes 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 /> Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use.70 Yes LI 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: 0^es LI No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: rx <br /> Camp stove Sterno .S. hotel trays (O \ \ <br /> Double steamer LI Steam table & lids b U Q Q V _> <"• <br />LI Electric stove top LI Other (specify) <br />JLJ A b00ttl w’1*1 wal,s and ceilin9 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 />(1 Q —Q_______ <br />> r . A A ft A—^LZ-S^i <br />pi c~.\ <4 .0_