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Environmental Health Department <br />i. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />I'.] Other (specify): <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 />[Tl^On-sito hose bib that is connected to a potable water source. <br />9. <br />moats, tamales, cooked beans, rice, <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 />I ] Stcrno & hotel trays <br />| | Steam table & lids j P* <br />I | Other (specify) <br />186B IL Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464 0138 | www.sjcchd.com <br />run IGO? PafjoVofn U-MI'liVI NTAI’I’ <br />07/3/1/ <br />7. <br />8. <br />The following is information about my organization/busincss: <br />Name of organization/busincss: Cnli Abfnta <br />_______ <br />SAN JOAQUIN <br />COUNIY <br />( >/ .•ill •, . h( . (■ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />( | Other (specify): _ <br />Electricity is provided for my booth’s use: IrbYes I | 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: I^Yes I J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />I | Camp stove <br />I | Double steamer <br />III ilcctric stove top <br />booth with walls and coiling constructed of cither wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanablc 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 />__________________ <br />____________ <br />Phone: () ...± .^..cl.Mbl Alternate: 9/3- ^^93 <br />List food to be sold or given to the public:. z_Qv»Co I..fel 'Ctely etc. <br />I am providing food that is NOT prepared at home: IXX051J 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 flics, <br />dust and the public) <br />Datefs);.?!^17;.20?3. <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 />1. Name of Event: LODI GRAPE FESTIVAL