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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: LODI WINE &FOOD FESTIVAL ^vate(s) Ap1z1L i, 201 ;L <br /> 2. The following is information about my organization/business <br /> Name-of organization/business: Lodi Crepes <br /> Address: P.O Box 2664, Lodi, CA 95241 <br /> Phone: ( ZOq ) _ Alternate. ( ) <br /> 3. List food to be sold or given to the public: Sweet crepes <br /> A. I 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: 3'14 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 /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar 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. <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. Electricity is provided for my booth's use:®Yes❑No <br /> 8. t am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: [9Yes❑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&lids <br /> ❑Electric stove top �'Other(specify) Co r,JJkl <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> EHQ 16-02 Pape 7 of 11 TEMP EVENT APP <br /> 728110 <br />