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Environmental Health Department Date(s):I.Name of Event: 1. 2. Address: Phone: 3. 4. 5. 6. 9. moats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. Approved bottled water. Ezf On-site hose bib that is connected to a potable water source. 7. 8. Other (specify):—-— Note: The only operations not required to provide enclosed booths Name of organization/business: n List food to be sold or given to the public: The following is information about my organization/business: All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. LODI GRAPE FESTIVAL SEPT1 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www-s^?^^E,JTAPp EHD 16-02 Pago 7 of 11 07/3/17 SANJOAOUIN !*’ -------COUNT Y Greatness grows here. TEMPORARY FOOD VENDOR’S APPLICATION Other (specify):_______________________—---------------------------------------------------- -—---------------------- the hot and cold holding of potency hazardous ! ZroS ~hot holding of all potentlaliy hazardous foods above 135°F: Q Camp stove (Zl Sterno & hotel trays Double steamer Pt Steam table & lids Electric stove top Other (specify) Note: Examples of potentially hazardous food Include: I am providing food that is NOT prepared at home: ® Yes No All food is prepared on-site or is from approved commercial facilities: 0 Yes No Name of facility: ---------------------------------- ---------------------------------Phone. {--------L_--------------------------------- famprovMbg a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ETA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable■ floor asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food prepaiation areas from the public. C/1, Alternate: ( )