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SAN J DAU M N 1-1--A- ronlYloi tat Health Dopa tment TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1 1.Name of Event. LODI WINE FESTIVAL pates) APRIL 1, 2023 2. The following is information about my organizallon/business: Name of organ lzatio l usines ' 1 X_ Address: _ ( �% r/7J Rhone: 3. List food to be sold or given to the public: I r u J f�J t� t n�?a�ai, a. 1 am providing food that is NOT prepared at home: ❑Yes D No All food is prepared on-site or is from approved commercial facilities: ❑Yes❑No Name of facility. _ Phone: Address of facility: 5. 1 am providing a booth with the following(to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with wails and ceiling constructed of either wood, 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 acceptable) and constructed to separate food and food preparation areas from the public. ❑Other(specify): 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).- 7. specify):r. Electricity is provided for my booth's use: [I Yes[ No 8 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation ❑Yes❑ No 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: I,]Camp stove I3 Sterno&hotel trays ❑Double steamer ❑Steam table&lids ❑Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products. 18G3 E. Hazelton Avenue I Stockton, Callfainiri 95205 l T 2C9 4513-3420 1 F 200,164-0138 1 v,rw sjc&%1 cam En 15-02 vaDe 7 or 11 MW FIVENTAaP 'n oar,7