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Environmental HealtVepartment <br />414 <br />1\11/ 2 3 20 /RON 4 4 TEMPORARY EVENT APPLICATION P 44/Vitolt <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departm',tLj 129 . <br />of the Food Vendor's Applications no later than two weeks prior to event <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: K <br />Date(s) of Event: 'S'L;•1-( 'LC) 2--9 Time of Event: I 7 (-'0 ?`11 <br />Location: \/c 441( \ \*(..\./. VOA AN) < G C <br />Event Coordinator (Name): M-e Telephone: -7-`114 <br />Mailing Address: '2 1111- L S e lz ditL <br />Number of Food Booths: <br />Approximate attendance at peak time: 7-OU Total Attendance: Average Age: 1Y0 <br />UTILITIES <br />Is potable water supplied and available for each food vendor: LI Yes RNo <br />Is electricity supplied and available for each food vendor: E Yes 41-No <br />Are janitorial facilities available: El Yes LI No <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: PI 11 coSic()-7010,-N Number of dumpsters: 6 <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 temp vent coordinator, I am responsible for meeting California State <br />standards and the EnvironmejaA, ealth Department policies and procedures. <br />Event Coordinator: /Date: <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sigov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023 <br />SANJOAQUIN <br />COUNTY— <br />Greatness grows here. <br />L