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Environmental Health Department <br />I <br />1. <br />z <br />Phone: <br />3. <br />4. <br />5. <br />I <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <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 />7. <br />8. <br />H On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: [3 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />H Stemo & hotel trays <br />jX] Steam table & lids <br /> Other (specify) <br />H 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 end food preparation <br />areas from the public. <br /> Other (specify): <br />i <br />f <br />SAN JOAQUIN <br />------COUNTY— <br />Grcatnc-sn ijraws hero. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: EJ Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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. Name of Event Lodi Beer Fest & BBQ Championship <br />Alternate: ( )i <br />List food to be sold or given to the public: Pfif/c fths Pv/kJ flodc SiMl <br />Turkey, Chicken, Pork, Beef, Sausage, 7 ' ' u <br />I am providing food that is NOT prepared at home: E Yes O No <br />All food Is prepared on-site or Is from approved commercial facilities: S 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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br />C/4 9537(2_________ <br />Date(s): April 27, 2019 <br />The following is Information about my organization/busteess: <br />Name of organizatlon/buslness:. <br />Mtoessr. 5^0 <br />) 7^7-6/77_________