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Environmental Health Department <br />1. Name of Event:1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />G. <br />fXI Approved bottled water. <br />[XI On-sito hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />II MI'LVI Ml API1 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />| | Camp stove <br />[ | Double steamer <br />[ | Electric stove top <br />7. <br />8. <br />Cone _ <br />SAN JOAQUIN <br />COUNTY <br />C . .J/ OlV. In<c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />18G8I-’. I la/ollon Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464 0138 | www.sjcehd.com <br />|,||()10.(12 I’.iflo/ofll THMPLVIN! <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 />| I Other (specify):------------------------------ ----------- -------------- --------------- ------------------------------——•— <br />Electricity is provided for my booth’s use: (XI Yes |.J 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 |., I No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135nF: ' Njvq •. Nb Hur Foofc <br />' | | Sterne & hotel trays <br />| | Steam table & lids <br />| I Other (specify) <br />O Other (specify):_____________________ <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />The following is information about my organization/businoss: <br /> Name of organization/businoss: l£-\j (m <br />S ,Q-, __ <br />Phone: ( ) - I?^>2- Alternate: ( ) <br />List food to be sold or given to the public: --------- <br />I am providing food that is NOT prepared at home: Yos [_.] No <br />All food is prepared on-site or is from approved commercial facilities: (XJ Yes | | No <br />Name of facility:Phone: (_ _J--------------------—... <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 />|>4 A booth with walls and coiling 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 clcanablc floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Datets): SEP 14-17, 2023