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Environmental Health Department <br />(> •.. <br />1. Name of Event:1. <br />2. <br />Phono: <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 />9. <br />7. <br />8. <br />SANJOAOUIN <br />COUN I Y <br />' H '-■■ i ■ /ii i- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is information about my^rganizati^n/businessj/y <br />Note: 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 throe (3) weeks prior to this event. <br />LODI GRAPE FESTIVAL <br />1868 L-. Hazelton Avenue I Stockton, California 95205 | T 209 468--3420 | F 209 464-0138 | www.sjcohd.com <br />IHl) 1(5-02 I’iigo/olll IEMP EVEN I API* <br />0//.VI7 <br />| | Approved bottled water. <br />|^On-sito hose bib that is connected to a potable water source. <br />| | Other (specify):- ----------- ------ ------------- --------- ------ ---------------- - <br />Electricity is provided for my booth’s useidrl 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: [/(I Yes | J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF: <br />| | Camp stove <br />| | Double steamer <br />( | Electric stove top <br />| | Stcrno & hotel trays <br />[. | Steam table & lids <br />Other (specify) <br />meats, tamales, cooked beans, rice, <br />| J A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mosh 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 />[j^-Other (specify):-- - <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 />_„.Date(S):.?^™ <br />The following is information about mynrganizatton/busi <br />Name of organization/business: //yy (/ & <br />Address: <br /> Alternate: ( ) __ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home^t Yes | ] No <br />All food is prepared on-site or is from approved commercial facilities: L’’| 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)