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Environmental Health Department <br /> DatG(s):I.Name of Event: Lodi Grape Festival1. <br />2. <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />8. <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />M j rx <br />>asure the hot and cold holding of potentially hazardous <br />No <br />SAN JOAQUIN <br />COUNTY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />3 o I - c/t I <1 <br />The following Is information about my organization/business: <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 />1868 E. Hazelton Avenue I Stockton, California 95205 [ T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TSM? A! <br />06/19/19 <br /> Other (specify): / <br />Electricity is provided for my booth's use: O Yes 0 No <br />I am providing an accurate probe thermometer to mi <br />foods during all times of booth operation: Yes 0 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />Name of organization/business: <br />Address: t | n <br />Phone: (^-O^l) 7 I H PC-:> Alternate: (’5' 10 ) <br />List food to be sold or given to the public: “Tn <- vtA vX&5 j <br />Vo-S1 j C.'i-O <br />I am providing food that is NOT prepared at home: Yes S^Jo <br />All food is prepared on-site or Is from approved commercial facilities: EkYes 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) W j <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 /> Other (specify): <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.