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rt= Environmental Health Department SAN .4JOAQUIN e — - - `COUNTY ` ^ " ' y� L ``�7F0!?T�'vJ' "� fCQth- 855 Pf2J �Y ? here . I TEMPORARY FOOD VENDOR' S APPLICATION f I All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to ; the festival coordinator three (3) weeks prior to this event. (( ; __ 1 . I . Name of Event: LODI GRAPE FESTIVAL �� ` Y Date(s) : f rlap ) 2 . The following is information about my organization/business : ! ro Name of organization/business . !� ° Address: O .cJ CCr44 Alternate: Phone: (ye� ) �X 3. List food to be sold or given to the public: COQ C4�I�Y 4. 1 am providing food that is NOT prepared at home:, Yes ❑ No All food is prepared on -site or is from approved commercial facilities: Yes E] No Name of facility: Phone: Address of facility: 5. 1 am providing a booth with the following : (to protect my unpackaged food and food-preparation areas from flies , I dust and the public) I > booth with walls and ceiling constructed of either wood , canvas, plastic, similar material and fine mesh fly screening , completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. r ❑ Other (specify) : Note: The only operations not required to provide enclosed booths are those which sell beverages from I approved dispensers, or prepackaged foods from approved sources . 6 . Approved water for drinking , utensil and hand washing will be provided in my booth by the following methods: i , ❑ Approved bottled water. Yon-site hose bib that is connected to a potable water source. i ❑ Other (specify) : 7. Electricity Is provided for my booth's use: Yes ❑ No 80 ometer to measure the hot and cold holding of potenti lam providing an accurate probe thermally hazardous foods during all times of booth operation : KYes ❑ No ' 9 . rol for the hot holding of all potentially hazardous foods above I am providing the following hot temperature cont 135° F : ❑ Camp stove ❑ Sterno & hotel trays i ❑ Double steamer ❑ Steam table & lids I El Electric stove top Other (specify) CG: Note: Examples of potentially hazardous food include: meats, tamales , cooked beans, rice, vegetables, potato salad, eggs, and dairy products. i 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 j F 209 464-0138 www.sjoehd . com EHD 16-02 Page 7 of 11 TEMP EVENT APP 0713117 j