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SAN JOAQUIN <br />COUNTY <br />Greatnesc grows here <br />Environmental Health Department <br />JUN 1 4 2024 TEMPORARY EVENT APPLICATION i'V/gRO/vAiE. <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health DeORMatistr htP.ALT, <br />GENERAL EVENT C <br />on <br />INFORMATIOI) <br />Name of Event: LAO n te2-2)10ns Ate <br />Date(s) of EvenS11>-310 VoT 3 L00, V ist.tre of Event: DO /4 DO <br />Location: Welt 4 di <br />to <br />Event Coordinator (Name): 4 , luz_. (Ai (1cR. <br />Mailing Address: 143 (.0 CI IC 4 /1 ) tOt <br />Number of Food Booths: 1 <br />of the Food Vendor's Applications no later than two weeks prior to event <br />Schbq <br /> <br />Telephone: 78(9— ca97) <br /> <br />Average AgcQ 6. Approximate attendance at peak time:c-)19/8 Total Attendan <br />UTILITIES <br />Is potable water supplied and available for each food vendor: :1----"Yes 11 No <br />Is electricity supplied and available for each food vendor: ,)'Yes El No <br />Are janitorial facilities available: )<LfYes El No <br />Number of toilets provided: / <br />Name of sanitary garbage disposal company: I Vet rb-t- <br />Method of disposal of liquid waste for food booths: Sin..K <br />Number of dumpsters: <br />APPLICATION <br /> <br />1. Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br /> <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 temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />Event Coordinato S 4,/e/TIY)1344--) <br /> <br />Date: Lii.(tC <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023