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NJOAQUIN t,- Lit 4 COUNTY <br />Greatness grows here. <br />RECEIVED <br />Environmental Health Department <br />AUG 1 LI 2024 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <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: ST.tASLL L. Foots recTiV44 <br />Date(s) of Event: 561D G I 1 4- ib Time of Event:NC:KW - le p 4,4 <br />Location: Ct10 Lk) .M i&Cil 1.-14 5 CO CV:ret..) CA q5 L0 <br />Event Coordinator (Name): P CrER tla ()Lc) ti Ad Telephone: g I 7 b 2 -7 a 2-0 4 <br />- Mailing Address: 2.4 47 -15 G <br />Number of Food Booths: I. 2 <br />Approximate attendance at peak time: Total Attendance:I 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: MYes No <br />Are janitorial facilities available: ErYes No <br />Number of toilets provided: L <br />Name of sanitary garbage disposal company: (Leib xi 13 Li Number of dumpsters7.7i - Na. <br />Method of disposal of liquid waste for food booths: L•141.1114_ 1.%)-crt. sibleS <br />APPLICATION <br /> <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 /> <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: <br /> <br />Date: eqz y <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 •Pg °so 2132_