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SAKJ0A0UIN <br /> Environmental Health Department <br /> CQUNTY— <br /> '•��iL;h�,�:a" Greutn�ss yros•:s ircre. <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 /> 1. 1.NameafEvent: Lodi street fair 2024 Date(s): <br /> 2. Thefollow€ng is information about my organizationibusiness: <br /> Name of organlzaUcn/business: The Lemon BOX <br /> Address: 708 Bradley Place Manteca, CA 95337 <br /> Phone: ( . ) 510-589�6166 Alternate:( ) <br /> 3. List food to be sold or given to the public: Lemonade, iced coffe, aqua fressa <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes®No <br /> All food is prepared on-site or is from approved commercial facilities:®Yes❑No <br /> Name of facility: Phone:f ) <br /> Address of facility: <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from ties, <br /> dust and the public) <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 an 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)- Commercial trailer 6x14 <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 /> 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ®Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use:❑Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous fonds above <br /> 135°F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top ❑Other(specify) NIA <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1866 E. Hazelton Avenue 1 Stockton,California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.corn <br /> EHD 16-02 Paga 7 of 11 TEMP EVENT APP <br /> 0713117 <br />