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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />1’1 Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />| | Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />__ _ Alternate: ( <br />Note: The only operations not required to provide enclosed booths arc those which soil beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />R| 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 are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />I | Stcrno & hotel trays <br />| | Steam table & lids <br />|. | Other (specify) <br />7. <br />8. <br />The following is information about my organization/busincss: <br />_____________ <br />. JL - __jLA.L_. <br />SAN JOAQUIN <br />c: o u m i y <br />• i! .. ■ . .pe-.v. lit .<• <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />„Date(s):lTJ±1?.’_????. <br />| | On-sito hose bib that is connected to a potable water source. <br />I I Other (specify): — <br />Electricity is provided for my booth’s use: 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: M Yes [ J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />| | Camp stove <br />I | Double steamer <br />| | Electric stove top <br />18(58 I... I lazelton Avenue I Stockton, California 95205 | T 209 468-3420 | I- 209 464-0138 | www.sjcohd.coin <br />I IIO 16 02. I’ago/ nfll TI-MI’I-VI NT API' <br />0//3/I7 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of (his checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: LODI GRAPE FESTIVAL <br />Name of organization/busincss: <br />Address: . <br />I ’hone: U d 7 ).. V 5 J24 „____ Alternate: ( ) <br />List food to be sold or given to the public: f?e <br />I am providing food that is NOT prepared at homo: Yes [J No <br />All food is prepared on-site or is from approved commercial facilities: W Yes I. J No <br />Name of facility:Phone: <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)