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Environmental Health Department <br />Dafefs): April 27, <br />tylddit Ss frrwIt/. hjMK- <br />Phone: <br />I <br />&;■ <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />EIT 530361’1’9X6 <br />I <br />rI <br />I <br />I <br />I <br />7. <br />8. <br />i <br />i <br />i <br />1 <br />I <br />t <br />““"AveHuel Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.S(c6hd.cxm <br />07/3/17 ' PdOoZofU TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />** t?( t - -7/ <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. i.Name of Event: Lodi Beer Fest & BBQ Championship <br />following Is Information about my organIzation/bualness: <br />Name of organization/buslness:____j <br />Address: — !0/7 i- S^3 pjf- qss/y <br />20/T0 39Vd P2=22 ST02/ET/60 <br />( <br />-List food to be sold or given to the public: <br />^Turkey, Chicken, Pork, Beef, Sausage?X ““ ------------- <br />ram-prowling food that is NOTcreoared at hormr E Yes [J No <br />All food Is prepared on-site or Is from approved commercial facilities: E Yes No <br />Name of facility: N/A Phone; () <br />Address of facility:'_______________ <br />1 XsTand the puSfoT fol,owins: (t0 pratect my ^packaged food end food-preparation areas from flies, <br />B A booth with walls and ceifing 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 />ar^^fro^ttT 8m00^ wood are acceptable) and constructed to separate food and food preparation <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 la connected io a potable water source. <br /> Other (specify);_______ <br />Electricity Is provided for my booth's use: [■] Yes No ' <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />. foods during all timoa of booth operation: B Yes No • <br />1 the fo,lowing hot temperature control for the hot holding of all potentially hazardous foods above <br />loo r* <br /> Camp stove w E Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electrio stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs.-and dairy products.