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12120504 <br />SAN JOAQUIN Environmental Health Department <br /> <br />COUN —'v <br /> <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: W rAtiliTint o n f-rt0- Fr'r <br />Date(s) of Event: 01 j „Noe, u';', Time of Event: 10 Cti").1 C5p 111 <br />Location: NI Pa,ry-, <br />Event Coordinator (Name):•,i() (inn Pjjt ele Telephone: (irl ti 4%22 - 1 <br />Mailing Address: <br />Number of Food Booths: 3,5 <br />Approximate attendance at peak time: Total Attendance: Average Age: <br />UTILITIES <br /> <br />., <br />Is potable water supplied and available for each food vendor: D Yes 0-No <br /> Is electricity supplied and available for each food vendor: D Yes X] No <br /> Are janitorial facilities available: D Yes No <br /> Number of toilets provided: 'i7 5 <br /> Name of sanitary garbage disposal company::At') i',r 144,1*.:0, Number of dumpsters: <br /> Method of disposal of liquid waste for food booths: <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 Departme t policies and procedures. <br />(p2q <br />. <br />Ycicinite <br />Event Coordinator. _L„..ef---/CA_A-4---•- <br />/ <br />Date: <br /> <br />1868 E. Hazeiton Ave rC e I Stockton, California 95205 I T 209 468-3420 F 209 464-0138 www.sjgov.org/ehd EHD 16-02 . Page 1 of 11 TEMP EVENT APP 06/29/2023