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Date: Event Coordinator: <br />SAN JOAQUIN <br />--COUNTY-- <br />Grrotness grows herr. <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: `cY\01 \ V, j 10{N, -\\R., \Of-- <br />3. <br />Date(s) of Event: Ss (31,-Nvoaik.,\ , ivy-A Time of Event: <br />Location: \NIC3 WON 6. r-"--0- — -Ito -F,. \A(Y)ciNcord Avi-c.... <br /> <br />4. Event Coordinator (Name)MrAYVX It.A\ALA(1,13-0— Telephone: voci 4L.0 1--(v S.--- i <br />Mailing Address: 2C\ S. 0,Ae,\(N .\,\ Lck y-i-e. rvAa ryi-e ccA j CA. 9 -.."3'3--7 <br /> <br />5. Number of Food Booths: C)--VIryy.... 12_ <br />UTILITIES <br />Is potable water supplied and available for each food vendor: /Yes El No <br />Is electricity supplied and available for each food vendor: D Yes yffNo <br />Are janitorial facilities available: El Yes ZrNo <br />Number of toilets provided: <br />Name Name of sanitary garbage disposal company:C*N ti" 0\00.'14 ECG, Number of dunnpsters: 2 <br />Method of disposal of liquid waste for food booths: N I <br />APPLICATION <br />Submit <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 />6. Approximate attendance at peak time: 5 00 Total Attendance: 5 0 (D Average Age: <br />1868 E. Hazelton Avenue J Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023 <br />PCo52 •?(2-3r-