Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.I .Namc of Event <br />2. <br />Address <br />Phone: Alternate () <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />G.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods' <br />LI Approved bottled water. <br />9. <br />'1 <br />7. <br />8 <br />El A booth with walls and ceiling constructed of cither 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 />pother (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 />IbGIJ I I la/clton Avenue | Stoi Mon. California 95205 | I 209 468-3420 1 F 209 464-0138 | ww'w.sjcclid.com <br />I < ? I’ajcZofll II VP( VI Nr Al'P <br />SAN JOAQUIN <br />• • i i;. i •. <br />LI Storno & hotel trays <br />(’ | Steam table & lids <br />I^lfOlhcr (specify) // ( /<■.< S <br />meats, tamales, cooked beans, rice,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 ___Daie(s)„SLPJ±1L2023 <br />I am providing food that is NOT prepared at home jX) Yes L.l No <br />All food is prepared on-site or is from approved commercial facilities'^ Yes LI No <br />Name of facility:Phone: ( ) <br />Address of facility: <br />I am providing a booth with the following- (Io protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />^>4On-site hose bib that is connected Io a potable water source. <br />[ | Other (specify)._______________________________________________________ <br />Electricity is provided for my booth's use ^fYes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation: M Yes LI 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 />| | Electric stove top <br />The following is information about my organization/busincss: <br />Name of organization/businoss: ) ( /r < ~ /\ c