Laserfiche WebLink
Environmental Health Department <br />I.Namc of Event:1. <br />2. <br />3. <br />A. <br />5. <br />^<3. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />1868 E I lazellon Avenue | <br />11 in ic o? <br />O/. A 17 <br />SAN JOAOUIN <br />c: (> 11 n i > <br />^^1-- Alternate: ( <br />unpackaged food and food-preparation areas from flics, <br />measure the hot and cold holding of potentially hazardous <br />Stockton California 95205 | T 209'168-3420 | F 209 464-0138 | www.sjcohd.coin <br />IMgcZol II irMPI vi m API’ <br />Date(s):^±l7^ <br />/ .^} > v/ ' I <br />)_______________ _____ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) arc 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 />The following is information about my organization/business: <br />Name of organization/business: 73-OL6 ZcAS. <br />Address: <br />Phone: ( 1 <br /> List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: J^Ycs No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No <br /> Name of facility:—---------------------------------Phone. (------- 1 <br />Address of facility:—----------------- <br />I am providing a booth with the following' (to protect my <br />dust and the public) <br />El 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 cleanab e fioor (concrete, <br />asphalt, clean tarps and smooth wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />///7/ r /-) 75^3 7-___ <br />Other (specify): Ld--------------- -------------------------------------------------------------------------- <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />| | Other (specify):------——— <br />Electricity is provided for my booth's use: pl Yes [J No <br />I am providing an accurate probe thermometer to mocr.: <br />I a^pro^iding the fSng h^UcmplSurKo^rol for the hot holding of all potentially hazardous foods above <br />135T: <br />| | Camp stove I .1 Sterno & hotel trays <br />[ 1 Double steamer ( J Steam table & lids <br />LJ Electric stove lop Other (specify) C <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.