Laserfiche WebLink
Environmental Health Department <br />G <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 pnor to this event <br />4th ol July at the Lake 7/4/2411 Name of Event Date(s). <br />2. <br />Name of organization/business: <br />629 Rutledge Dr Lodi Ca, 95242Address <br />406-7021Phone( 209 )Alternate ( 209 )ROR-I APD <br />3 List food to be sold or given to the public Beer on Tap. Vodka Lemonade canned beer canned Seltzer and txjnied water <br />4. <br />5 <br />Moblie Bar Horse Trailer0 Other (specify): <br />i <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9 <br />Note: Examples of potentially hazardous food include:meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />7 <br />8 <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />The following is information about my organization/business <br />A Hilchin Good Timo <br />SAN JOAQUIN <br />COUNTY - <br />I am providing food that is NOT prepared at home’ Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities 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 /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal 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 />foods during all times of booth operation Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F <br />0 Camp stove <br />0 Double steamer <br />0 Electric stove top <br />1368 E Hazelton Avenue | Stockton California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />0 Other (specify) Hand Washing sink with water storage <br />Electricity is provided for my booth's use’ 0 Yes O No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous