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Environmental Health Department <br />nateW: April 27, 2019I.Name of Event:1. <br />2. <br />Phone: <br />3. <br />4. <br />6. <br />6. <br />■ <br />■ <br />r SANJOAOUIN <br />-----COUNTY----- <br />Gruatnca giu.vs he.'f, <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 to <br />the festival coordinator three (3) weeks prior to this event. <br />Lodi Beer Fest & BBQ Championship <br />.■ <br /> <br />meats, tamales, cooked beans, rice, <br />;Ai|^terrioihgtei>ays <br />^^ SleWi taMeAl* < ; <br />3ttier.(speclfy)''//orz50X. <br />...... <br />The following Is Information about my organization/business: <br />Name of organization/business: —/^X &Ck. <br />Address: Ofi/C ,£>£. C/> <br />£70 ) Alternate: (^ZjT) 5^7/ ~ <br />List food to be sold or given to the public: <br />Turkey, Chicken, Pork, Beef, Sausage, /^oco^A-, <br />I am providing food that Is NOT prepared at home: 0 Yes No <br />All food Is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: N/A Phone: ( ) <br />Address of facility: ____ <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 />0 A booth with walls and celling 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 />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> Approved bottled water. <br />.0 On-site hose bib that is connected to a potable water source. <br />! [3 Other(specify):. ____________,*--------;—s--------- <br />, ?8. ' ra^^vldl^ <br />.foodsduT^ <br />■ i ^^ l am p^dlhg the following hot temperature control for the hot holding of all potentially hazardous foods above <br />» llWqstovetop , <br />0^)0 vSbleR.’pc D°'en * ’ <br />.•yj..: