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091 IDq2_ <br />Environmental HeaItheDartment <br />AlAy 2 2 2024 <br />SAN JOAQUIN <br />COUNTY <br />s qrw 111 r <br />Eivv/RolvA . <br />TEMPORARY EVENT APPLICATION PeRivirvrAt HEA in, To be completed and signed by Event Coordinator, then returned to the Environmental Health Department wiytrro mil 1:1 <br />of the Food Vendor's Applications no later than two weeks prior to event <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: 44ee,eji <br />Date(s) of Event: .e/r, 7/3, 8/11) 9/1 <br />Location: /e-de4-- /473 t Z ,e7. tpo'- 4 957544" <br />Event Coordinator (Name): Telephone: ( <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: Total Attendance: Average Age: <br />UTILITIES <br /> Is potable water supplied and available for each food vendor: Yes No <br /> Is electricity supplied and available for each food vendor: 1 Yes r] No <br /> Are janitorial facilities available: El Yes El No <br /> Number of toilets provided: <br /> Name of sanitary garbage disposal company: Number of dumpsters: <br /> Method of disposal of liquid waste for food booths: <br />APPLICATION <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 />0- Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />pr 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 />Time of Event: <br />Event Coordinator: <br /> <br />re 4 <br /> <br />Date: <br /> <br />N. <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 of 11 TEMP EVENT APP <br />06/29/2023