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57^3^7 <br />Environmental Health Department <br />Date(s):1. <br />2. <br />Sacramento, CA 958222495 Fruitridge RoadAddress: <br />Phone: <br />3. <br />4. <br />5. <br />(xl Other (specify): I prepare popcorn, caramel corn and nuts at a Indoor booth. All machines have protective barrier around them. <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods:6. <br />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <br /> A booth with walls and celling 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 cloanablo 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 />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 />1. Name of Event:Lodi Grape Festival. <br />09/16-19/2021 <br /> Storno & hotel trays <br /> Steam table & lids <br />Q Other (specify) nachos cheese machine has built in heater <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/chd <br />EHD 16-02 Pago 7 ol 11 TEMP EVENT APP <br />06/19/19 <br />SAN JOAQUIN <br />COU N TY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist <br />to the festival coordinator three (3) weeks prior to this event. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at homo: 0 Yos No <br />All food Is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: Lodi Graps Festival 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 />0 Other (specify): Kitchen sink and handwash sink _____________________ <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 times of booth operation: Q 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 />Q Camp stove <br /> Double steamer <br />0 Electric stove top <br />The following is information about my organization/buslnoss: <br />, , , „ , Lakeside Products Inc dba "Jerry's Gone Nuts" <br />Name of organlzation/business:___________________________________ <br />( 916 j 346-4080 Alternate: ( (209) )2fiMflZ5 <br />11st food to be sold or given to the public: Roasled nuls- beof jerky, popcorn, Nachos w/ cheese sauce, caramel corn, giant dill pickles, sods