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Environmental Health Department <br />I.Namc of Event:1. <br />2. <br />Phone: <br />3. <br />4. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />I | Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />[ I Storno & hotel trays <br />I'/.Steam table & lids <br />Other (specify) <br />1. <br />8. <br />(■0_On-sito hose bib that is connected to a potable water source. <br />SAN JOAQUIN <br />COUN I Y <br />v. /ku- <br />TEIVIPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />18(58 1 I lazolton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.coni <br />1110 1602 I'iigo 7 <>( 11 II Ml’l!VI Ml Al'l1 <br />07/3/17 <br />I | 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 cloanablc floor (concrete, <br />asphalt, clean tarps and smooth wood aro acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />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 />__ <br />_J3ate(s):.£SlJ±lL????. <br />I am providing food that is NOT prepared at homo: l/J Yes [ ,| No <br />All food is prepared on-site or is from approved commercial facilities: KI Yes | J No <br />Name of facility: Phone: <_______________ <br />Address of facility: '5^1'?... . <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 />| | Other (specify): <br />I ilcctricily is provided for my booth's uso.Jkj 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 | J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />I | Camp stove <br />I | Double steamer <br />I | Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: ___ <br />Address: XI <br />) Alternate: (^^ ). <br />List food to be sold or given to the public: