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Environmental Health Department <br />required to return a signed and completed copy of this checklist <br />1. I.Name of Event: .Lodi Grape Festival.Date(s): <br />2. <br />£ <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />Name of organization/buslness: <br />Address: <br />7. <br />8. <br />) <br />List food to be sold or given to the public: Cf>/A 6a<:e<L <br />SAN JOAQUIN <br />COUNTY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />9. <br />670 <br />The following Is Information about my organization/buslness: <br />'T/ir <br />/hthdiLii. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www sjqov orq/ehd <br />oS?Ji69°2 Pago 7 o(11 TEMP EVENT APP <br />).___________ <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 bo provided In my booth by the following methods: <br />^•Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />_______ <br />tobj (LA <br />Alternate: ( <br />I am providing food that is NOT prepared at home: 0 Yes No ger/-/ <br />All food is prepared on-site or Is from approved commercial facilities: S Yes No <br />Name of facility: Phone: <br />Address of facility: CA 9 5^7^ <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 />P 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 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 r , ' <br />to the festival coordinator three (3) weeks prior to this event. <br /> Other (specify):_________________________ <br />Electricity is provided for my booth's use: Yes S^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:'^] 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 sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.