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SANJOAQUIN <br />COUNTY <br />Grfu)triess grows her e _ <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 />Location: \ LO liNCI)Cit(-- t\) g AV e -1\-\je • rib.rYte C Cc 1 Ca.. 9,c31 <br />Event Coordinator (Name): ‘ icvey)t INN501\ CAA—Telephone: (2_ )9 4%(..c) • is- t t GI <br />Mailing Address: '2. S C-VA eV la_i Lc-e.(e-Cc, C. 9s---a37 <br />Number of Food Booths: , <br />Approximate attendance at peak time: 3 (-)n Total Attendance: ,.b. 0 0 Average Age: <br />UTILITIES <br />Is potable water supplied and available for each food vendor: L Yes o <br />Is electricity supplied and available for each food vendor: El Yes <br />Are janitorial facilities available: Eli Yes_o <br />Number of toilets provided: -4- <br />Name of sanitary garbage disposal company: C..Xt \I N4 alaniCcoN Number of dumpsters: <br />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 Environ alth Department policies and procedures. <br />Event Coordinator #: Ire 7471 Date: 6 I/wi14- <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 <br />Name of Event: <br />Time of Event: V Date(s) of Event:3 ‘1 S I 2._ C <br />GENERAL EVENT Flitn <br />k <br />FORTATION <br />V)Inn <br />56 M(\ie <br />2-1÷