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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />06/16/2023Primary's Food Truck Event Datc(s)I.Name of Eveni1. <br />2. <br />Name of organizatiorVbusiness: <br />3 E Gibson St. Stockton CA. 95204Address <br /><831 ) 406-8956 ) Alternate (Phone <br />Baked potatoes, roasted corn, sweet potatoes3List food to be sold or given to the pubic: <br />4, <br />5 <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />XI Approved bottled water <br /> On-site hose bib that is connected to a potable water source. <br />9 <br />meats, tamales, cooked beans, rice. <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 />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 lo separate food and food preparation <br />areas from the public. <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1868 E Hazelton Avenue | Stockton. Calrfornia 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06T6T9 <br />The following is information about my orgamzalion/business <br />Speedy’s potatoes <br />SAN JOAQUIN <br />COUNTY <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 /> Other (specify) <br />Electncity is provided for my booth's use: K) Yes 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. XJ Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />XI Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home XI Yes No <br />All food is prepared on-site or is from approved commercial facilities: 52 Yes No <br />Name of facility:Phone: ( ) <br />Address of facility <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)