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Environmental Health Department <br />I.Namc of Event:1. <br />2. <br />3. <br />4. <br />5. <br />I'. l Other (specify):.. <br />Approved waler for drinking, utensil and hand washing will bo provided in my booth by the following methods:G. <br />|>4 Approved bottled water. <br />|>( On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />mi ai’p <br />Note: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />7. <br />8. <br />SAN JOAQUIN <br />COUNIY <br />( x •. <>iv. in i c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />(XI A booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cloanable 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 />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />18(58 I.:. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcohd.com <br />i no m o? Paoozofii r:: <br />07/3/17 <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 />LODI GRAPE FESTIVAL <br />| ] Other (specify):________________ <br />Electricity is provided for my booth’s use: M Yes | J No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />I am providing food that is NOT prepared at homo: tXI Yes | I No <br />All food is prepared on-site or is from approved commercial facilities: XI Yes | | No <br />Name of facility:Phone: X ). <br />Address of facility: ___ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />foods during all times of booth operation: (XI Yes [„| No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />laiTF: IxiXZMrAdws, fbols. <br />I | Camp stove <br />I | Double steamer <br />( | Electric stove top <br />Datefe): SEP <br />| | Steam table & lids <br />| | Other (specify) <br />The following is information about my organization/businoss: <br />Name of organlzation/business:. <br />Address: c vcood , <br />Phone: ( ) — Alternate: ( ) <br />List food to be sold or given to the public: