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0 0002/000304/16/2019 8:10 AM FAX <br />Environmental Health Department <br />1.1. Name of Event LODI Pate(s): APfrlL27,2019 <br />2. <br />Address; <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Received Time Apr. 16. 20 1 9 9:06AM No. 4935 <br />7. <br />8. <br /> Sterno & hotel trays <br />Spteam table & Btfe <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br /> Approved bottled water. <br />1B68E. Hazelton Avenue ] Stockton. Califomis 95205 | T 209 488-3420 [ F 209 464-0138 | www.sjcehd.com <br />OTWI?^2 Paaa/otll ■ TEMP EVENT APP <br />SANWOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is infonnation about my organizatlon/business: <br /> On-site hose bib that is connected to a potable water source. <br />^Other (specify): AyyjL WOSVO <br />Electricity is provided for my booth's use* y - — <br />I am providing an accurate probe thermoi <br />foods during all times of booth operation: <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135DF: <br /> Camp stove <br />k? Double steamer <br />^S^lectric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 /> 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 />^Other (specify): <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 />Name of organization/business: <br />Phone: <br />Ust food to be sold or given to the public/'^ 5, <br />Yel QNo <br />kter to measure the hot and cold holding of potentially hazardous <br />N Yes DNo <br />Alternate; I <S <br />I am providing food that is NOT prepared at home. [Rjes No <br />All food is prepared orv-site or is frojnapproved commercialfaciGtje9:^3<tfes Q No , <br />Name of facility Phone: <br /> Address of facility.. J L-i Co irp. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparaTOh areas from flies, <br />dust and the public)