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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Namc of Event:1. <br />2. <br />3. <br />4. <br />5. <br />A- <br />G. <br />9. <br />K <br />7. <br />8. <br />SAN JOAOUIN <br />c: ( )l I N I Y <br />moats, tamales, cooked beans, rico, <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />(he festival coordinator three (3) weeks prior to this event, <br />LODI GRAPE FESTIVAL <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | wvvw.sjcehd.com <br />(Innn 7 nf 11 iniw* uVui'ii •nil) 16.02 I ago/oiii <br />O//3/17 <br />DaW,): SEP 11-17, 2023 <br />QU3 S> A <br />Wil, <br />Alternate: ( 7^7 ) ------- <br />J t ^>V ______ ________— <br /> Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br /> Other (specify):_—-------- - --------------------------------------- - ----------------------- <br />|Eam providing0^? accurate7 probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation:© Vos No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />PI Camp stove D Sterno & hotel trays <br />Double steamer O Steam table & lids <br /> Electric stove top Other (specify) (v<<V <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Name of organization/business:^) u \\ CC Vs " <br />Address: Pn. ftox <br />Phone: (lO1? ) O <br />List food to be sold or given to the public: "S <br />I am providing food that is NOT prepared at home: [^J Yes (ZJ No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes [Z] No <br /> Name of facility: y/ A—----------------------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 /> A booth with walls and celling 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 (concre e <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Other (specify): | -----<-OAa<>S>ow <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 />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: