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Environmental Health Department <br />Date(s1. <br />2. <br />^£556 <br />3. <br />4. <br />5. <br /> Other (specify): <br />i6. <br />I9. <br />meats, tamales, cooted beans, rice. <br />Page 7 of 11 TEMP EVENT APP <br />I I i <br />i <br />S 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, i <br />7. <br />8. <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 fol owing methods: <br /> Approved bottled water. <br />I am providing food that is NOT prepared at home: H 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-preparat on areas from flies, <br />dust and the public) <br />SAN40A0UIN <br />? UW- ! COUNT Y <br />’ Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | vyww.sjcehd.com <br />EHD 16-02 ! Page 7 of 11 TZT.TZ'.'Ztn <br />07/3/17 <br />All food vendors (both for prpfit and non-profit) are required to return a signed and completed copj/ of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />1. Name of Event: Lodi Beer Fest & BBQ Championship <br />E On-site hose bib that is connected to a potable water source. <br /> Other (specify): !________________________________________________ _______________ <br />Electricity Is provided for my booth’s use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all tlme^ of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: B n <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top J^Jpther (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />. April 27, 2019 <br />The following is information about myorganization/buslness: <br />Name of organizatlon/business: *7 A <br />Address: <br />Phone: (faCf) 4 7^ Alternate^ ) <br />List food to be sold or given to the public: Shelf stabls seasonings & sauCQS