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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 /> the festival coordinator three(3)weeks prior to this event. <br /> 1 1.Name of Event. LOD) 1i'.ti`a, z f cv5i\�F;b <br /> 2. The following is information about my organ ization/busine�sfs: <br /> Name-of organization/business: <br /> Address: <br /> Phone: {�j�) (G b '�J L Zj� Alternate: ( } <br /> � pr <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home: ©Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ®Yes❑No <br /> Name of facility: Lodi Grape Festival Phone: (209)369-2771 <br /> Address of facility: 314 E. Lockeford St., Lodi CA 95240 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from Flies, <br /> dust and the public) <br /> nK'with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> scr ng, with <br /> 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 /> Other(specify): v�T "� '�CU�-(A V � <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 potable water source. <br /> ❑ Other(specify): <br /> 7, Electricity is provided for my booth's use: ©Yes❑ No <br /> S. 1 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. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑ Sterno&hotel trays <br /> ❑ Double steamer ❑Steam table &fids <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> EHC 19-02 Page 7 of ii TEMP EVENT APP <br /> 712617 0 <br /> le�tue7 asaUUn <br />