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Environmental Health Department <br />1. <br />2. <br />Address: <br />Phono: <br />3. <br />4. <br />) <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAOUIN <br />COUNTY <br />he:- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />vegetables, potato salad, eggs, and dairy products. <br />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 />All food vendors (both for profit and non-profit) are <br />IBOai -lluzoKonAvonucI Stockton. California 9B205 | T 209 468-34MI P 209 464.0138 | www.sjcchd.com App <br />El II) 1B-0? I’nflo/ofll <br />O7/.1/I7 <br />[ | Approved bottled water. <br />| | On -site hose bib that is connected to a potable water source. <br />« Other (specify): <br />“vXan'IS; probe themomotCT^measure the het end cold holding of potontialiy hazardous <br />I am"providing the folTovSng Mt'tomporaUiro co^Tol feHhe hot holding of all potentially hazardous foods above <br />135OF: <br />| | Camp stove I I Sterno & hotel trays <br />| | Double stoanier I I Steam table & lids <br />| | Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />___.Date(s):^!L±!^?l1. Name of Event: <br />The following is information about my organization/business: <br /> Name of organization/business:-------------------------------—--------------— <br />P. . <br /> ( Alternate: ( O/fc ). 06b ----------- <br /> <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at homo: Jxf Yes [ J No <br />All food is prepared on-site or is from approved commercial facilities: 1.1 Yes LI No <br /> Name of facility:_______________—------------------------------------phono: i- — <br /> <br />lam^o^dlng a booth with the following: (to protect my unpackagod food and food-preparation areas from flies, <br />dust and the public) <br />I I 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 cloanable 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 />M Othor (specify):. ------------------------------------ <br />Noto: The only operations not required to provide enclosed booths arc those which sell beverages fiom <br />approved disponsors, 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.