Laserfiche WebLink
Environmental Health Department <br />Date(s):1 .Name of Event:Lodi Grape Festival 1. <br />2. <br />Name of organizalion/business: <br />Address: <br />4802383711Phone:() <br />List food to be sold or given Io the public:3. <br />4. <br />5. <br />d 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 />0 On-site hose bib that is connected to a potable water source. <br />9. <br />7. <br />0. <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 />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209'168-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 7 of 11 TEMP EVENT APP <br />06/19/19 <br />SAN JOAQUIN <br />C. OU N I Y <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is information about my/rgaPKalianlx/cjfp^l ■ ■ r-% 4- k-v Cf" I iff <br />sWwkesler DfCTianaieFAz85226" <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist <br />to the festival coordinator three (3) weeks prior to this event. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Q Yes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br />0 Double steamer <br />0 Electric stove top <br />Q Storno & hotel trays <br />0 Steam table & lids <br />0 Other (specify)griddle <br />meats, tamales, cooked beans, rice, <br />__________ Alternate: ( ) <br />Gyro/gatlic chicken pita, phiUy cheese steak, loaded fries <br />alligator on a stick frog legs, lemonade <br />I am providing food that is NOT prepared at home: LJ Yes O No <br />All food is prepared on-site or is from approved commercial facilities: O Yes 0 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 flies, <br />dust and the public) <br />0 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 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 />0 Other (specify):-------------------------------------- --------------------------- --------------------------------------------------------------- <br />Electricity is provided for my booth's use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous