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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />MARCH 28, 2025Date(s):l .Name of Event:1. <br />2 <br />£1 Address: <br />i c-cPhone: <br />0List food to be sold or given to the public:3. <br />4. <br />1 <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided m my booth by the following methods:6. <br />Q Approved bottled water. <br />r. -t: <br />meats, tamales, cooked beans, rice, <br />7 <br />8 <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 ] www.sjcehd com <br />EHO 16-02 Pago 7 of 11 TEMP EVENT <br />07,3 17 <br />Alternate: ( ) <br />i C / t-t <br />SAN JOAQUIN <br />COUNT Y <br />1 -I tri <br />I • J <br />Noto: 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 />LODI WINE FESTIVAL <br />Acj ( J <br />5ii <br />VV <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 />All food is prepared on-site or is from approved commercial facilities: D Yes S No <br />Name of facility: < I f‘J P T2 5 Phone: ( <br />Address of facility:__ <br />I I am providing a booth with the following, (to protect my unpackaged fooa and food-preparation areas from flies, <br />dust and the public) <br />The following is information about my organization/business: <br />Name of organization/business: 1 I \ n S M 0 (AU »_ <br />H i J c Ih.Q Qe. 4 / - i 39 <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): |v* iv-U'i. << H/ <br />Electricity is provided for my booth's use: Yes Q No <br />J IpJ 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 />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />VIA 135°F: r->’ ' Camp stove U Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify)