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Environmental Health Department <br />1. Name of Event:1. <br />2. <br />Address: <br />Phono: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meals, tamales, cooked beans, rice, <br />II MP I VI Nl Al’l"I’acio 7 of 11 <br />7. <br />8. <br />SAN-JOAQUIN <br />C O U N ( Y <br />(i •. . f fir*.. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 l-ESTIVAl. <br />1868 I: Hazelton Avenue | Stockton. California 9920') | T 209 468 3420 1 E 209 464 0138 | www.sjcelKl.com <br />HID 10 02 Pa<|0 /of11 IIMPI VS N! <br />07/3/17 <br />____DateCs):.8!'3!2!1512024 <br />I | Approved bottled water. <br />^On-site hose bib lhat is connected to a potable water source. <br />( J Other (specify):---------------------------- ----- ---- ---------------------------------- <br />Electricity is provided for my booth’s use: XI Vest I 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 | .1 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />| | Camp stove <br />| I Double steamer <br />| | Electric stove top <br />| | Sterno & hotel trays <br />I | Steam table & lids <br />•|yfOther (specify) H/A <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />| J Other (specify):------------------------------------------------------------------------------------------------------------ ------ — <br />Noto: The only operations not required to provide enclosed booths aro 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 />The following Is information about my organization/business: > > <br />Name of organization/business: MV- M <br />............. <br />Alternate: ( ) <br /> <br />L.ist food to bo sold or given to the public: VreSh squewJ <br />I am providing food that is NOT prepared at home:)tj Yes □ No <br />All food is prepared on-site or is from approved commercial facilities: Yes LI 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 flics, <br />dust and the public) <br />A booth with walls and coiling 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 arc acceptable) and constructed to separate food and food preparation <br />areas from the public.