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SANJOAQUIN Environmental Health Department COUNTY-- Greatnes5 ernwc he• TEMPORARY FOOD VENDOR'S APPLICATION 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. Name of Event: Freedom Fest Date(s): 06/20/2024 The following is information about my organization/business: Name of organization/business: The Home Church Address: 11451 N West Lane, Lodi, Ca 95242 Phone: (209) 339-7333 Alternate: (209) 479-2685 List food to be sold or given to the public: Hot Dog, Tr-tip, Iced Coffee, Cotton Candy, Shaved Ice, Nachos, French Fries, Churros, Tacos, Oreos, Corn I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: Vi Yes No Name of facility: The Home Church Phone: ( 209 339-7333 Address of facility: 11451 N West Lane, Lodi, Ca 95242 I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 0 A 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. Other (specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: I21 Approved bottled water. El On-site hose bib that is connected to a potable water source. 12 Other (specify): Electricity is provided for my booth's use: Vi Yes No I am providing an accurate probe thermomet to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: y Yes El No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: 0 Camp stove Sterno & hotel trays El Double steamer El Steam table & lids El Electric stove top 0 Other (specify) Crock-Pots Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. 1868 E. HazeIton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP 06/19/19