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SAOAQUIN Environmental Health Department <br />J! <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />LODI WINE FESTIVAL I.Name of Event:1. <br />2. <br />/■jq <br />/c •<:;;.!/Address:■-1, <br />) Phone:( •■ > ) <br />'.• / /eVLisi food to be sold or given to the public:3. <br />4. <br />[ 1 Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6. <br /> Approved bottled water. <br />L __-t. <br />7. <br />meats, tamales, cooked beans, rice. <br />I: <br />tr . FV ,VP <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 />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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />'668 £ Hazelton Avenue i StocKtcn Califo-- 1 <br />FHD 16-02 <br />07 3 17 <br />5. <br />I 20 <br />Pago r o' • ’ <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Date(s): .06/2024 <br /> Alternate: ( <br />I am providing food that is NOT prepared at home: Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: H Yes Q No <br />Name of facility: (,• //// iJ f-' Phone: (;?")’( ■ ' . <br />Address of facility: | /| ( 1 £ A » v ( ' i >. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />The following is information about my organization/business: <br />Name of organization/business: / / > \ <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): /j //// > -V 7/ <br />Electricity is provided for my booth’s use: Yes 0 No <br />8.in 'I am providing an accurate probe thermonietor to mioasure the hot and cold holding of potentially hazardous <br />9.J-