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Environmental Health Department <br />1. Name of Event:1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />|._I Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />II MP I VI NI Al’I’ <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 />| | Stcrno & hotel trays <br />| | Steam table & lids <br />[ | Other (specify) <br />7. <br />8. <br />SAN JOAQUIN <br />COUN IY <br />< .-.i. . /h /. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />- <br />1868 I :. Hazelton Avenue I Stockton. California 915205 | T 209 468-3420 | F 209 464 0138 | www.sjcehd.com <br />(•nt) iao? Pogo r of ii <br />(17/3/1/ <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 Datofs):.^12;15:2024 <br />The following is information about my organization/business: <br />Name of organization/business: <br />___ <br /> (,x<iPhone: ( ^l\ > 'I'* /_______-________Alternate:()_Z1L <br />List food to bo sold or given to the public: • | pS./' ll Ui l ________ <br />I am providing food that is NOT prepared at homo JZ] .yes | | No <br />All food is prepared on-site or is from approved commercial facilities: |/| Yes | I No <br />Name of facility: Phono: /I <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 />|\| 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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods: <br />^71 Approved bottled water. <br />iy] On-site hose bib that is connected to a potable water source. <br />I | Other (specify): / <br />Electricity is provided for my booth’s use: V| Yes I 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 | | No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />| | Camp stove <br />| | Double steamer <br />| 11-lectric stove top