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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): SCp H1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SANJOAOUIN <br />COUNTY - <br />no Hazelt°n Avenuel Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjcehd.com <br />Page7of11 TEMPEVENTAPP <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 />1. Name of Event: LODI GRAPE FESTIVAL <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 /> 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: jgfYes 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:^Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />O Camp stove Q Stemo & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top pother (specify) [Cx <br />meats, tamales, cooked beans, rice, <br />The following is information about my organization/business: / <br />Name of organization/business: 7 / A H 5 / <br />Address: iS '/4; /! C2A- ‘iSoSl <br /> Alternate: ( ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:Jg[Yes No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes 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 />J^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 /> Other (specify):