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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s)SEPTEMBER 14-17,20231. Name of Event: LODI GRAPE FESTIVAL1. <br />2. <br />Address: <br />( 714 )925 4701Phone: <br />) 3. <br />4, <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />9. <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />18(58 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov.orcj/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />y\ booth with walls and ceiling 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 cleanable 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 />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 />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />List food to be sold or given to the public: Alternate: ( <br />hotdogs,corndogs, burger, fries <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities^] Yes 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 flies, <br />dust and the public) <br /> Approved bottled water. <br />\j] On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s usQ>0Yes 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: 0'Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />The following is information about my organization/business: Name of organization/business: <br />PO Box 54988 Irvine ca 92819 Wesl C°asl "'eanies DBA Slrau<l En.srprlses