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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY— <br />Greatness grows here. <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: crei3 A Drtrq Dry t-Jb >uqi 'PtJ3 A 262Z1 <br />Date(s) of Event 541‘ cit-sA OcT 2.zj Time of Event: 4 44- C- <br />Location: MCON7A-IP4 IL err) itAL Pace_44-. <br />4, Event Coordinator (Name): gi-vefril v- Bias.) Telephone: (cm) 1 2 b 1q81 <br />Mailing Address: 1-190 N Vets/Tug-A gle(Ci is-ic up/ TA' A^zif -311 <br />Number of Food Booths: 5 <br />Approximate attendance at peak time: 40m Total Attendance: 6 en) Average Age: 311 <br />UTILITIES <br />Is potable water supplied and available for each food vendor aVes 0 No <br />Is electricity supplied and available for each food vendor ErVes 0 No <br />Are janitorial facilities available: Erces 0 No <br />Number of toilets provided: 3 <br />Ter:vci bEcTA gag--""5. Name of sanitary garbage disposal company: v,#444- 1.4 Number of dumpsters: I <br />6. Method of disposal of liquid waste for food booths: <br />APPLICATION <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 temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />54A/m^,%^114-- 12a-•d-9- Event Coordinator: Date: 1/ 8/ <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 1 www.sjgov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/292023 <br />Scanned with CamScanner