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SAN J O Q U I N Hiol -jh. u 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 10 <br /> the festival coordinator three(3)weeks prior to this event. <br /> I. 1.Name of Event:_LODI WINE FESTIVAL Date(s): APRIL 1,2023 <br /> 2 The following is information about my organization/busin(ess <br /> Name of organization/business: 5 r� _ /a yr <br /> Address: 7J7��/ >�� 4 ami Ue L C7 <br /> Phone 09 ) 6,� �� / Alternate. <br /> 3 List food to be sold or given to the public: r°3 .5— <br /> �..__ . lrr <br /> 4. 1 am providing food that is MOT prepared at home: ET/Yes❑ No / <br /> AIf food is prepared on-site or is from approved commercial facilities: [i]1/es❑No <br /> Name of facility 4 eoV-L,s�rrc._ phone. (&9) �d5'-6s --( <br /> Address of facility:_/V/3 7 Ais o <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 /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, simiiar 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. r- <br /> ❑Other(specify): /O!� e r/ <br /> Note: The only operations not required to provide enclosed hooths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources <br /> 0. A��ppmvvud water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> � <br /> ppro ed bottled water. <br /> Zn-site hose bib that is connected to a potable water source <br /> ❑Other(specify): <br /> T Electricity is provided for my booth's use: Pes❑No <br /> 8. l am providing an accurate probe Ihennometer to measure the hot and cold holding of potentially hazardous <br /> foods during all limes 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 R hotel trays <br /> E 6ouble steamer ❑ Steam table& Ws <br /> ❑Electric stove top ❑Other(specify) <br /> Moto: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E Hazelton Avenue I Stockton, California 962051 T 209468-3420 1 F ;109 464-0138 f www slcehd cont <br /> FHS 16-02 Page 7 of 11 TFAAP EVFNST APP <br /> 07M7 7 <br />