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SAN JOAQUIN F'.nvironrnental Health Department C O U I•I'I Y-- TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and cooiploted copy of this checklist to the festival coordinator three(3)weeks prior to this event. N111-1 `fir"r 2,02�, 1. 1.Name of Event: Lodi street f=aire Dale(s): � 2. The following is information about my organizationlbuslness: Name of organization/business: Sunset 5eekar5 LLC Address: 30 N Goulo Slreel Ste R Sheridan WY 828 1 Phone: ( 209 ) B-34-6511 Alternate: Kinoiio Mushroom Coffee 3. List food to be sold or given to the puhltc: 4• 1 and providing food that is NOT prepared at home: Z Yes❑ No All food is prepared on-site or is from approved commercial facilities: ®Yes❑No Name of facility: rntelli ant Blend Phone: Address of facility: 5330 East ate 17-11 San r);- 5 )i5. 1 ani providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with walls and ceiling constructed of elther woad, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceplabfe) and constructed to separate food and food preparation areas from the public. re® We are riot preparing coffee on site.Our coffee will be sold in individual 30 serving bags that art- [N Other(specify): sealed. No food preperation is necessary Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources, 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. ❑On-site hose bib that is connected to a potable water source. ❑Other(specify): WA we will not be providing water. 7. Electricity is provided for my booth's use:❑Yes❑x No 8. 1 am providing an accurate probe thermometer to meastire the hot and cold holding of potentially hazardous foods during all times of booth operation: ❑Yes EI No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 1357: ❑Canip stove ❑Sterno&hotel trays ❑ Double steamer ❑Steam table&lids NA we are only F] Electric stove tap U Other(specify) selling pre packaged coffee Note: Examples of potentially hazardous food Include: ineats, tamales, cooked means, rice, vegetables, potato salad,eggs,and dairy products. 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-3420 1 F 209 464.0138 1 www,sjcehd.com El in 16-02 Pogn 7 of 71 TEMP EVENrAPP 0719117