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Mailing Address t <br /> <br />5 Number of Food Booths <br />) 6 Approximate attendance at peak time Total Attendan e Average Ag <br />••••• • 1•••• •••• wwwww •••••••••••••• •• Amirlime •••• .••• •••• • am • gliir • MID <br />iTM utiiihmovrtywiel <br />—COUNTY— <br />Greotness grows here. 12.-.0 SOS —1 ( <br />0. TEMPORARY EVENT APPLICATION 003 (9 5t <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: 4-0_4 OA C It \or <br />2. Date(s) of Event: ),, ,,,,z t.)' , ,-,1 )0{ Time of Event: 11 I i..,, <br />3 Location:"1.. o.• •`, .: •-• A ,- ‘A I\ v, c L i <br />4 Event Coordinator (Name) _L <br />UTILITIES <br />Is potable water supplied and available for each food vendor. 5:1 Yes D'No <br />Is electricity supplied and available for each food vendor: E Yes 0 No <br />Are lanitorial facilities available E Yes No <br />4 Number of toilets provided '1 <br />5 Name of sanitary garbage disposal company: • <br />6 Method of disposal of liquid waste for food booths <br />APPLICATION <br /> <br />Number of dumpsters <br /> <br />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 />di 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 800 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 Coordinator <br /> <br />° <br /> <br />-./ <br /> <br />Date: <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiend <br />END 16-02 Page 1 oil 1 TEMP EVENT APP <br />06,2912023 <br />0\ \ \ P 5 c (7k \ <br />. . <br />gr <br />Telephone ( )