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Environmental Health Department <br />I.Namo of Event:1. <br />2. <br />Phono: <br />3. <br />4. <br />5. <br />[ | Other (specify):. <br />Approved water for drinking, utensil and hand washing will be provided in niy booth by the following methods:6. <br />9. <br />moats, tamales, cooked beans, rice, <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 />I | Sterno & hotel trays <br />I ’vf^team table & lids <br />| | Other (specify) <br />to measure the hot and cold holding of potentially hazardous <br /> No <br />1868 I -.. I lazelton Avenue I Stockton, California 95205 | I 209 468-3420 | I- 209 464-0138 | www.sjcehd.com <br />HiniGO? Pago/ofll ICMP I.VI Nl API’ <br />(I//3/IZ <br />7. <br />8. <br />li'A] A booth with walls and ceiling 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 clcanablc 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 />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 GI?APE FESTIVAL <br />SAN JOAQUIN <br />COUN I Y <br />( <t .'.ll • ./l iMV'. Il< ' (■ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Datefs): SEP 14-17, 2023 <br />[ "| Approved bottled water. <br />j^On-sitc iioso bib that is connected to a potable water source. <br />| | Other (specify): <br />I -lectricity is provided for my booth's use: I vfYcs i. j No <br />I am providing an accurate probe thermometry to i ’, ' <br />foods during all times of booth operation: |.'iT Yes (_J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°lr: <br />I | Camp stove <br />| 11 )ouble steamer <br />| 11 -loctric stove top <br />The following is information about my organization/businoss: <br />e- food Conce SsfcnS , <br />„ __CAi__SS_k4’_s2_ <br /> (^1 ) 402'" 3*? _ <br />Name of organization/businoss:. <br />Address: )HSr> Sold <br />Alternate: <br />List food to be sold or given to the public: Opr p CxtY <br />I am providing food that is NOT prepared at homo: l^Ycs |_.] No <br />All food is prepared on-site or is from approved commercial facilities: [/Q Yes No <br />Name of facility: Phone: (1 <br />Address of facility:_____ <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)