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'U'"�� SAN 1GAOUIN p <br /> � Environmental Health Department <br /> COUNTY <br /> `r�tv Greatness grows here. <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, 2024 Time of Event:7:00 - 11:30 am <br /> 3. Location: Lodi Lake Park- 1101 W. Turner Road, Lodi, CA 95242 <br /> 4. Event Coordinator (Name): Jonell Steckman Telephone: (209} 642-1723 <br /> Mailing Address: P.O. Box 761 Lodi CA 95241 <br /> 5. Number of Food Booths: Qne <br /> 6. Approximate attendance at peak time: 400 Total Attendance: 3,500 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: Stationary Building at Park <br /> 5. Name of sanitary garbage disposal company: Waste Management Number of dumpsters: 3 - 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$162 <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 /> • $162 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$729.00 <br /> This application is to be completed and signed by the Event Coordinator, then returned to the <br /> Environmental Health Department with all Food Vendor's Applications no later than two weeks prior to the <br /> event. <br /> I understand that as a tempura event coordinator, I am responsible for meeting California State <br /> standards and the Environmental alth Department policies and procedures. <br /> Event Coordinator: Date. April 5, 2024 <br /> 1868 E. Hazelton enue 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 /> 06/2912023 <br />