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I. <br />SANIJOAQUIN <br />COU N Y-- <br />Grea tne giows <br />05.t-12.2_cgo <br />Environmental Health Department <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: <br />Date(s) of Event: '‘)..1\-f,...... \ st -2_ ,--2.,,Lf Time of Event: NVIIIN — "Np Arl <br />k4-) 00‘..c y 0n V teit-erks a rti-e r - Location: <br />Telephone: rIcr-f.... (0 (9E- _ -5°0 4 Event Coordinator (Name): C_C‘..A— i MS <br />Mailina Address: ts. 33 6 C.- /41-%/C..- ."1:t. 3 tct, I ...v.,,,,v._ I-2y\ (A- ci „,--1 <br />Number of Food Booths: <br />Approximate attendance at peak time: 5 ty0 Total Attendance: st, 0 Average Age: So <br />UTILITIES <br />Is potable water supplied and available for each food vendor: ft Yes fl No <br />Is electricity supplied and available for each food vendor: Yes 0 No <br />Are janitorial facilities available: 1-Yes 0 No <br />Number of toilets provided: 0 <br />Name of sanitary garbage disposal company: t.3 V\ Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br /> 6k.s2A. <br />APPLICATION <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 />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: e)'A)4NA Date: VP-kA <br />1858 E. Hazelton Avenue I Stockton. California 95205! T 209 468-3420 I F 209 464-0138 www.sjgov.oratehd <br />END 16-02 Page 1 of 11 TEMP EVENT APP 06/29/2023