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SAN,JOAQUIN <br />— -C OUN —v Environmental Health Department <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 prior to this event. <br />2. The following is information about my organization/business: <br />Name of organization/business: Original Soft Taco LLC <br />Address: 5339 S. Cherry Ave <br />Phone: <br /> <br />3. List food to be sold or given to the public: Hot dogs, hamburgers, breakfast burritos, chips, <br /> <br />5. I <br />am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> <br />4. I am providing food that is NOT prepared at home: [i] Yes 0 No And sodas. <br />Address of facility: 413 E. Lockeford St. Lodi, CA. 95240 <br />All food is prepared on-site or is from approved commercial facilities: C.4 Yes LI No <br />Name of facility: Lodi Grape Festival kitchen Phone: ( ) 209-369-2771 <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 cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. <br />Other (specify): Lodi Grape Festival Kitchen <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />Other (specify): Kitchen sinks <br />Electricity is provided for my booth's use: IN Yes 0 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: [81 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: <br />LI Camp stove LI Sterno & hotel trays <br />Ej Double steamer 0 Steam table & lids <br />0 Electric stove top E) Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue l Stockton, California 95205 l T 209 468-3420 F 209 464-0138 l www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP 06/29/2023 <br />1. 1.Name of Event: Lodi dog show <br />Date(s): 4/11-14/24 <br />) 559-630-5445 <br />Fresno, CA 93706 <br />Alternate: ( ) 209-774-6301