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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUN -v <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 />Name of Event: 'CL--\-- Eak.klaf A R--A-zactr. O /.. <br />Date(s) of Event: 3 tine.— c9g-96)Vme of Event: c 3i),\•-• <br /> <br />S-A-Lo - q Sad Location: C_ --1 i . 0, vj %- .A c1-0 Cil- <br />Event Coordinator (Name): (.?-190..,,,e 4..) Telephone: 9c9, Lin - I q 1,-'3 <br />Mailing Address: -1 l. - CcoMiy.o. \ Jcvt ,--k-13(t...1-01\ Ori- atSplS- <br />Number of Food Booths: <br />Approximate attendance at peak time: "(00 Total Attendance: 1 0 0 Average Age: <br />UTILITIES <br />Is potable water supplied and available for each food vendor: .11-Yes LI No <br />Is electricity supplied and available for each food vendor: iff-Yes ID No <br />Are janitorial facilities available: n No <br />Number of toilets provided: (C? .,,A <br />Name of sanitary garbage disposal company: wci-A-c._ vi -Number of dumpsters: CZ <br />Method of disposal of liquid waste for food booths: Lcciu,tt Coy-ATEA" e s _ <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 Coordinator: vt.) Date: <br /> <br />/ kw <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 1 0111 TEMP EVENT APP <br />06/29/2023