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Environmental Health Department <br />Name of Event:1. <br />Time of Event: 6:00pm-9:00pm2. <br />3. <br />4.Telephone: (209) 831-6210 <br />5. <br />Approximate attendance at peak time: 800 Total Attendance:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4, <br />Number of dumpsters: 25. <br />6. <br />APPLICATION <br />1. <br />2. <br />Amanda E Jensen 8/12/25Date:Event Coordinator: <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of $179 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Date(s) of Event: <br />Location: <br />IX] Yes <br />H Yes <br />0 Yes <br />□ No <br />□ No <br />□ No <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/01/2025 <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 />1,6oo <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $179 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 $805.50 <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 />GENERAL EVENT FILE INFORMATION <br />City of Tracy Block Party_________ <br />September 5, 2025 <br />Front Street Plaza (6th & Central Avenue) <br />Amanda Jensen <br />a SAN.JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: 10 <br />Name of sanitary garbage disposal company: Tracy Disposal Service <br />Method of disposal of liquid waste for food booths: N/A <br />Event Coordinator (Name): <br />Mailing Address: 333 Civic Center Plaza, Tracy, CA 95376 <br />Number of Food Booths: 1 <br />v A °o 11 <br />Average Age: $5-50