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SaN JOAQUIN Environmental Health Department <br /> Ln r4, —COUNTY-- <br /> TEMPORARY EVENT APPLICATION <br /> To be completed and signed by Event Coordinator,then returned to the Environmental Health Department with all <br /> of the Food Vendor's Applications no later than two weeks prior to event <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: Kiwanis Club of Greater Lodi Foundation Pancake Breakfast <br /> 2. Date(s) of Event: July 4, 2023 Time of Event: 7:00- 11:00 AM <br /> 3. Location: Lodi Lake Park at 1101 W. Turner Road Lodi CA 95242 <br /> 4. Event Coordinator (Name): Chet Somera Telephone: (209)329-5047 <br /> Mailing Address: P.O. Box 761 Lodi CA 95241 <br /> 5. Number of Food Booths: One <br /> 6. Approximate attendance at peak time: 400 Total Attendance: 3,000 Average Age: 25 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ® Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ® Yes ❑ No <br /> 3. Are janitorial facilities available: © Yes ❑ No <br /> 4. Number of toilets provided: Stationer yr Building at Park <br /> 5. Name of sanitary garbage disposal company: Waste Management Number of dumpsters: 33 -4 Yard <br /> 6. Method of disposal of liquid waste for food booths: Transported to Certified Dump Station <br /> APPLICATION <br /> 1. Submit the following to the Environmental Health Department two weeks prior to the event: <br /> a) Temporary Event Application <br /> b) Application Review Fee of$156 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List <br /> 2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br /> • $156 per hour(weekdays 8:00 am to 5.00 pm) <br /> • After regular business hours (weekday, weekends and holidays)the inspection is charged at a <br /> minimum three-hour overtime rate of$702.00 <br /> This application is to be completed and signed by the Event Coordinator, then returned to the Environmental <br /> Health Department with all Food Vendor's Applications no later than two weeks prior to the event. <br /> I understand that as a temporary event coordinator, I am responsible for meeting California State standards <br /> and the Environmental Health Department policies and procedures. <br /> Event Coordinator: a6Date: June 20 2023 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />