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SAN 10 AU U I N Environmental Health Department C ; �i J ''•J I • 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 Date(s): APRIL 1,2023 2. The following is information about my organ izationlbusiness: Name of organization/business: I�_A i�_ T l o) Ec Address: J r V Phone: � 16 ) I �, rl -_ (,,,1} l Alternate: 3. List food to be sold or given to the public: 4. 1 am providing food that is NOT prepared at home: ❑Yes XNo All food is prepared on-site or is from approved commerciai facilities:XYes ❑ No Name of facility: N_ ?� 1. 15,E P.P_A Phone: hidc� Address of facility: r.� ndy IA) I J-) 5. 1 am providing a booth with the following: (to p(otect my unpackaged food and food-preparation areas from flies, dust and the public) F-1 A booth with walls 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. I Other(specify); _�_�— �1 �1 —1 5 —P ! _l� ('�.__(]f l-COY_.+-O k1 C,�.+t- )I [w6 l " 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-s4e hose bib that is connected to a potable water source. ❑ Other(specify): N�n 7. Electricity is provided for my booth's use: ❑ YesxNo N J A 8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: ❑ YesjRNo WA9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135F: ❑ Camp stove ❑ Sterno& hotel trays ( ] Double steamer U 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. 1868 E. Iiazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 J www sjcehd,com I I II)16-0 Pago 7 of 11 11 MF'EVENT APP 07!3117