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GENERAL EVENT FILE INFORMATION <br />Lodi Buddhist Church Food Bazaar1.Name of Event: <br />2. <br />3. <br />4.Telephone: (209) 361-7571 <br />5. <br />150 600 35 years6.Approximate attendance at peak time:Total Attendance:Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />Waste Management 15.Number of dumpsters: <br />City Sewer6. <br />APPLICATION <br />1. <br />2. <br />jEvent Coordinator:■&t=. <br />Page 1 of 11 <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 />EHD 16-02 <br />08/01/16 <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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />|X] Yes <br />E Yes <br />[X] Yes <br />□ No <br />□ No <br />□ No <br />^Mi­ <br />ls 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: <br />Method of disposal of liquid waste for food booths: <br />w <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($208.50 per hour) <br />TEMP EVENT APP <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 />-AzC/O S 6 _________ Date: /Vq Q \ I? , XC <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd^P/p j <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 />Date(s) of Event: 06/28/2025 Time of Event: 12:00 pm-7:00 pm <br />Location: Lodi Buddhist Church, 23 N. Stockton St., Lodi, CA 95240 <br />Event Coordinator (Name): Phil Nagata <br />Mailing Address: 23 N. Stockton St., Lodi, CA 95242 <br />Number of Food Booths: 2_______________________ <br />2025 <br />'^Hr <br />'ces