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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:Lodi Grape Festival.Date(s):1. <br />2. <br />Address: <br />Alternate: (Phone: <br />fcywM3.) <br />I am providing food that Is NOT prepared at home:(4.Yes,No <br />Phone: <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />D Approved bottled water. <br />D On-site hose bib that is connected to a potable water source. <br />D Other (specify) <br />Electricity is provided for my booth's us No?. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the <br />festival coordinator three (3) weeks prior to this event. <br />D Other (specify): <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from approved <br />dispensers, or prepackaged foods from approved sources. <br />D 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, asphalt, clean <br />tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. <br />The following is information about my organization/business: <br />Name of organization/business: Surff'T V 4^*//- <br />i>.o. Ac/ /‘/Uy <br />List food to |)e sold i^r given to the public: <br />SAN JOAQUIN <br />COUNTY <br />All food is prepared on-site or is from approved commercial facilities: D Yes D No <br />Name of facility: <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and <br />the public)