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Environmental Health Department <br />SEP 11-14,2025Date(s):I.Name of Event:1. <br />2. <br />ZZ^ Name of organization/business: <br />3. <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 /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <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 />|/| 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 />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 4G4-0138 | www.sjcehd.com <br />01016 02 PageZofll II MPIWI-NI API’ <br />07/3/17 <br />135°F: <br />I I Camp stove <br />[’/I Double steamer <br /> Electric stove top <br />■■•'./roV' <br />Noto: 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 />LODI GRAPE FESTIVAL <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: |/j Yos 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 Yes I I No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br />LI Steam table & lids <br />LI Other (specify) <br />r.>SANJOAOUIN <br />kL1 ' —COUNTY— <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Address: <br />Phone: (^^"V )Alternate: ( <br />List food to be sold or given to the public: Z; ; <br />I am providing food that is NOT prepared at home: ^l Yes U No <br />All food is prepared on-site or-io from approvod commorcial facilities: l/lYes 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 />The following is information about my organization/business: <br />//WO