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SAN JOAQUIN Environmental Health Department <br />• "Ik ) vName of Event: <br />2. <br />3. <br />4. <br />75. <br />6.Total Attendance: Average Age: <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <br />r<:k' /r. <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 S179 <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 />1368 E Hazel! <br />EHD 16-02 <br />07/01/2025 <br />, jrgehd <br />TEMP EVENT APP <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 />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: /fa <br />Name of sanitary garbage disposal company:'w*. > <br />Method of disposal of liquid waste for food booths: <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• SI 79 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 S805.50 <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 />1. <br />-JI. <br />P (I oo 35% <br />A cxxi i m <br />~7 / <br />Time of Event: <br />[ (O cC \ c <br />____Telephone: (7/4* <-7 7 'j / ) J <br />/L t r , iI . u (‘ /'■ ;1 \ 3 J J <br />(' Jy N i C'1 --; n s h <br />Date(s) of Event: Adj <br />Location: GOATyyJ .Vrifk v vi n H > <br />Event Coordinator (Name): G-H-k-' V, ./h.n <br />Mailing Address: 6-J4/ < l-ii/J-Mki <br />Number of Food Booths: ( <br />Approximate attendance at peatCtime: j. <br />05 | T 2"9 4 58- J420 | F 4d4-.h <br />Page 1 of 11 <br />,■ . t M .-T I