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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />06/11/2025Freedom Fest1.1. Name of Event:Date(s): <br />2.The following is information about my organization/business: <br />The Home ChurchName of organization/business: <br />11451 N West Lane, Lodi, Ca 95242Address: <br />Phone:339-7333(209)479-2685Alternate: (209) <br />3. <br />4. <br />5. <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />tamales, cooked beans, rice,meats, <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 />g(|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 <br />areas from the public. <br />Qher (specify): <br />1868 E. Hazelton Avenue I 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 />SAN JOAQUIN <br />- COUNT'/ <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Sterno & hotel trays <br />Q Steam table & lids <br />Other (specify) Crock-Pots <br /> Other (specify): ___ ____ <br />Electricity is provided for my booth's use:j2fYes Q 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:gfYes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Camp stove <br />Q Double steamer <br /> Electric stove top <br />List food to be sold or given to the public: Hot Dog, Tri-tip, Iced Coffee/Tea, Shaved Ice, Nachos, <br />French Fries, Tacos, Oreos, Corn, Funnel Cake, Ice Cream <br />I am providing food that is NOT prepared at home.gfYes Q No <br />All food is prepared on-site or is from approved commercial facilities^ Yes [J No <br />Name of facility: The Home Church Phone: ( 209) 339-7333 <br />Address of facility: 11451 N West Lane, Lodi, Ca 95242 <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)