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Environmental Health Department <br />SEP 12-15,2024LODI GRAPE FESTIVALI.Name of Event:1.Date(s): <br />The following is information about my organization/business:2. <br />Name of organization/business: pretzel bros <br />15918 mountain view dr, nevada city, ca, 95959Address: <br />) 760-421-9426Phone:( <br />3. <br />4. <br />5. <br /> Other (specify):enclosed food trailer <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <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 />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 209 464-0138 | www.sjcehd.com <br />EHO 16-0? Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br />Alternate: ( ) <br />salted, cinnamon, almond toffee, garlic, parmesan, Cheddar, bacon <br />List food to bo sold or given to the public: cheddar jalapeno, pizza, nacho cheese, marinara cream cheese, ranch <br />Q Sterno & hotel trays <br />I ] Steam table & lids <br />Smother (specify) steam warmer <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 three (3) weeks prior to this event. <br />SAN JOAQUIN <br />COUNTY <br />Ci i co I /’<’ ■> $ </i (■ s *> f i e. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />'^Approved bottled water. <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: pK/es 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: C^Yes 0 No <br />I am providing the following hot temperature control for (ho hot holding of all potentially hazardous foods above <br />135°F: <br />0 Camp stove <br />0 Double steamer <br />0 Electric stove top <br />I am providing food that is NOT prepared at home:'^s7es 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 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)