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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUN <br />sr Grea tness 9row, ; <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: t...titLOOt *IS Q., <br />Date(s) of Event: 1 -1 2,1- 14 Time of Event: <br />Location: tAvicvlAilis $&1Ac ii s. v1-00114 s s-r- Loot cts 240 <br />4 Event Coordinator (Name): .a06 C141.61-• Telephone: (1) 10-- 06,13 <br />Mailing Address: -0 O. (i• LOO‘ cpk- ci41,14-1, <br />Number of Food Booths: <br />Approximate attendance at peak time: 1.00 Total Attendance: (00 0 Average Age: .10 <br />UTILITIES <br /> Is potable water supplied and available for each food vendor: LI Yes Li No <br /> Is electricity supplied and available for each food vendor: El Yes Et-No <br /> Are janitorial facilities available: EirYes No <br /> Number of toilets provided: <br />5, Name of sanitary garbage disposal company: kaN4-1-12 tin Coy% Number of dumpsters: <br />6. Method of disposal of liquid waste for food booths: 141A <br />APPLICATION <br />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 />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.sjgov.org/ehd <br />EHD 16-02 Page 1 of lit TEMP EVENT APP <br />06/29/2023 <br />\206Lk6k03