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PRISCOL Z <br />Environmental Health Department <br />Name of Event:1. <br />2. <br />3. <br />4. <br />5. <br />Average Age:6. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Tejdeep S RattanEvent 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 /> Yes <br /> Yes <br /> Yes <br /> No <br /> No <br /> No <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 />ryn. ct\ <br />\ ..-y <br />Mountain mikes Pizza Dog fAthRr(hnt dogs) and Main Squeeze I emnnade <br />Approximate attendance at peak time: 200 Total Attendance: 500 AvAranp Aha- 22 <br />SAN JOAQUIN <br />-COUNTY— <br />Greotness grows here. <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 />GENERAL EVENT FILE INFORMATION <br />Community Creep-in_____________________________________ ____ <br />Date(s) of Event: October 17th, 2025 Time of Event: 4pm-7pm <br />Location: Hansen Park, 1175 Vecindad St, Tracy, Ca 95391 <br />Event Coordinator (Name): TeJdeeP s Rattan Telephone: (937) 3697843 <br />Mailing Address: 919 S Fulton St, Mtn house, Ca, 95391 <br />Number of Food Booths: <br />Date: 8/28/2025 <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 />UTILITIES <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: <br />Name of sanitary garbage disposal company: west valley disposal Number of dumpsters: J. <br />Method of disposal of liquid waste for food booths: covered waste container