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ec'' SAN JOAQUIN y <br />COUNTY <br />,,co v'./ Greatness grows here. <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 />GENERAL EVENT FILE INFORMATION <br />Name of Event: S'SRCe. Srtn, Rot s. CAv Sktio <br />Date(s) of Event: Arra 1L-7 1 2-0/?•‘1/- Time of Event: (NI — 3/9n4 <br />Location: 30096 40:9'S-Orl Atlaa -11-act CA q 30 (I- <br />Event Coordinator (Name): CI PI d,etin-e-4( Telephone: (20q) 642.4-01k/ <br />Mailing Address: 3 ooco-33 -- )Laisev. jZd <br />Number of Food Booths: 3 <br />Approximate attendance at peak time: Goa Total Attendance: 360400 Average Age: 112=r <br />UTILITIES <br /> Is potable water supplied and available for each food vendor: 116 Yes 0 No <br /> Is electricity supplied and available for each food vendor: ki Yes 0 No <br /> Are janitorial facilities available: Pil Yes 0 No <br /> Number of toilets provided: (1) <br /> Name of sanitary garbage disposal company: Vskx,Y-emarusfartak Number of dumpsters: <br /> Method of disposal of liquid waste for food booths: 1>Mper-34-Q <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 />NAA-Q-,\1 nikealindo <br /> <br />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 11 MP P-VPKIT APP <br />06/29/2023 vizo;Li Protk u