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SANJOAQUIN <br />COUNTY <br />04132L+1r1,../ <br />Greatness grows here. <br />Fa9-102 <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 I FO TION <br />Name of Event: <br />Date(s) of Event: <br />Location: <br />Event Coordinator (N AG <br />Mailing Address: r-9--e- <br />Number of Food Booths: kl 71 <br />ime of Event: <br />Telephone:49 47/ ‘--(KtS.-g <br />6. Approximate attendance at peak ime: Total Attendance: <br />UTILITIES <br /> Is potable water supplied and available for each food vendor: ['Yes <br /> Is electricity supplied and available for each food vendor: ['Yes <br /> Are janitorial facilities available: Yes <br /> Number of toilets provided: <br /> Name of sanitary garbage disposal company: <br /> Method of disposal of liquid waste for food booths: <br />APPLICATION <br />Average Age: <br />\JK1 No <br />No <br />El No <br />Number of dumpsters: <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 temporaryev-- coordina • I am r sponsible for meeting California State <br />standards and the Environmenta _He Depart ies d procedures. <br />Event CoonclinafOr: Date: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-01 8 I www.sjgov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023