Laserfiche WebLink
"'AN M,A O U I N 1.rivirunmentai Health Department <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 /> the festival coordinator lhreo (3)weeks prior to this event. <br /> 1. 1.Name of Event: LODI WINE FESTIVAL — _ Date(s): APRIL 6,2021 <br /> 2. The following is information about my organization/business: <br /> Name of organization/business:—010n�bu <br /> Address: _ � <br /> Phone: <br /> 3. List food to be sold or given to the public:.---.—C_A1--'qe <br /> h. 1 ant providing food that is bjQ.j prepared at home: k Yes[I No <br /> All food is prepared on-site or is from approved commercial facilities: ( J Yes L]No <br /> Name of facility: � _ 4�ffir �1"'"n_ Phone: (d(gi6,A �_A I� <br /> Address or facility: IY� __Ldy �_ <br /> 5. 1 a1n providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> �1 A booth with walls and ceiling constructed or either wood,canvas,plastic,similar material and fine mash 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 front the public. ` , } <br /> Other(specify): <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, Clectri4cily is provided for my booth's use: ❑Yes,,No — <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operalionC Yes RNo <br /> 9. 1 yam providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135*F: <br /> 0 Camp stove ❑ Sterno&hotel trays <br /> []Double steamer []Steam table&lids <br /> Electric stove top Other(specify) 1J1A <br /> Note: Examples of potentially hazardous food include: rncats, tunlmlcs, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. liazoltan Avenue{ Stockton.California 95205{ T 209 4(38-3420 1 F 209.46,1-0138 1 %r7ww.sjcehd.com <br /> r=11D tBAP. P.VQ 7 of 11 TEMP r_VEiVT APP <br /> 071117 <br />