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SAN JOAQUIN <br />wilt4; COUNTY--- <br />dastSvAr <br />Environmental Health Department <br />ploso2s--t-ko <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 /> <br />1. Name of Event: 12,--/-o ci(clok_ fii-5-fri(1(1 1)11 <br /> <br />2. Date(s) of Event: Set.ity\tavg.._ a, ).4,--q-- Time of Event: <br />14, eflAd-e-14 Cc — <br />Event Coordinator (Name): A Athol cal rls4ki Telephone: ( <br />Mailing Address. L.) bO( 10)- <br />• <br />Number of Food Booths: <br />Approximate attendance at peak time: fob t) Total Attendance: /1)4d Average Age: 7477 <br />UTILITIES <br />Is potable water supplied and available for each food vendor: 24es EI No <br />Is electricity supplied and available for each food vendor: I;j4es EI No <br />Are janitorial facilities available: 12es CI No <br />Number of toilets provided: /-0 <br />Name of sanitary garbage disposal company: racod— Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />APPLICATION <br />Submit the following tdthe 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 Envir nmental Health Department policies and procedures. <br />3. Location: <br />- <br />Event Coordinator: Date: <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 of 11 TEMP EVENT APP <br />06/29/2023