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SAN JOAQUIN <br />COUNTY <br />Greatness grows here. <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 />Name of Event: MHSRC India Independence day Celebration <br />Date(s) of Event: 08/10/2024 <br /> <br />Time of Event: 4PM to 9:30PM <br /> <br />Location: Central Community Park, 25 Main St, Mountain House, CA 95391 <br />4 Event Coordinator (Name): Kaleem Mohammed Telephone ( 6 50 278-0028 <br />Mailing Address: 1485 S Wilshire Ave, Mountain HOuse, CA 95391 <br />5. Number of Food Booths: <br />Approximate attendance at peak time: 600 Total Attendan (600 Average A <br />UTILITIES <br />Is potable water supplied and available for each food vendor: 21 Yes [1] No <br />Is electricity supplied and available for each food vendor: Yes I21 No <br />Are janitorial facilities available: Yes 111 No <br />Number of toilets provided: 4 <br />Name of sanitary garbage disposal company: West Valley Number of dumpsters: 1 <br />Method of disposal of liquid waste for food booths: Waste Bins with liners <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 />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 Kaleem Mohammed Dat e 08/10/2024 <br />1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023 W09-MI\