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Environmental Health Department <br /> SAN JOAQUIN <br /> COUNTY— <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 /> Vie festival coordinator three(3)weeks prior to this event. P1 %� <br /> 1. 1,Name <br /> of Event: Lodi Stref date(s): /October j <br /> 2. The following is information about my organizationlbuslness: J <br /> Name of organization/business: Sourdough !31 Wh <br /> Address: 10004 Avocado Wav E <br /> Phone: ( , 916 230' -i -z—Alternate:( ) Be /J <br /> 3. List food to be sold or given to the public: Sourdough e T <br /> 4. 1 am providing food that is NOT prepared at home:❑Yesx No <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yex No <br /> Natne of facility: Phone: <br /> Address of facility: <br /> 5. 1 am providing a booth with[lie following: (tq protect my unpackaged food arid food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screenkng, completely enclosing open food areas. II 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. V^ I/P <br /> El Other(specify): I <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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a polabke water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes No <br /> B. 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: ❑YesNo <br /> 9. 1 am providing the following hot temperature contr r the hot holding of all potentially hazardous foods above i <br /> 135'F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑double steamer ❑Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,egos,and dairy products. <br /> 1868 E. Hazelton Avenue II Stockton, California 95205 f T 209 468-3420 I F 209 464-0138 k www.sjcefiid.coo N APP <br /> EH❑16.92 Page 7 of 11 <br /> W/3117 <br />