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TEMPORARY FOOD VENDOR’S APPLICATION <br />Paters): SEP 14-17, 20231.I.Namc of Event: <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <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 />(3 On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />Pago 7 of H <br />Noto: 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 />7. <br />0. <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> A 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 />(JJ'Other (specify): ( S' H C-? (jw <br />SAN JOAQUIN <br />c: r )t i N I > <br />Environmental Health Department <br />I am providing food that is NOT prepared at homo: El Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes EJ No <br />Name of facility: JV 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 />Noto: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />1860 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Fl ID 16 02 I’ago 7 of 11 1FMP EVENT APP <br />O//3/17 <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 />C A d <br /> Alternate: (‘ V x <br />c*. <br />The following is information about my organlzation/buslness: <br />Name of organlzation/buslness: <br />P.O Z-ZiC < A *-1 ____ <br />List food to be sold or given to the public:____ <br />I I Other (specify):_____________________________________________ <br />Electricity is provided for my booth's use: (kl 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: Cl Yes Fl No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br />O Steam table & lids <br />(3 Other (specify) < a \ \ v w |) 5 <br />4. S