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1. <br />2. <br />3. <br />Telephone: (209) 712-20994. <br />5. <br />3,4006.Total Attendance: <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: J 2 4 yard5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: May 1,2025Event Coordinator: <br />Temporary Event Application <br />Application Review Fee of $172 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />0 Yes <br />0 Yes <br />0 Yes <br />□ No <br />□ No <br />□ No <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness 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 />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $172 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 $774.00 <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 />GENERAL EVENT FILE INFORMATION <br />Kiwanis Club of Greater Lodi Foundation Pancake Breakfast <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: Standard Park Use Toilets <br />Name of sanitary garbage disposal company: Waste Management <br />Method of disposal of liquid waste for food booths: Transported to Certified Dump Station <br />Name of Event: <br />Date(s) of Event: ^7 2025 Time of Event: 7 00 - 11 30 am <br />Location: Lodi Lake Park -1101 W. Turner Road, Lodi, CA 95242 <br />Event Coordinator (Name): ^ae Whitby-Brummer <br />Mailing Address: P.O. Box 761 . Lodi, CA 95241 <br />Number of Food Booths: One <br />Approximate attendance at peak time: 600 <br />Environmental Health <br />/5 2025 <br />TEMPORARY EVENT APPLICATION4^o^^ <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health uep^fiA^yj^hall <br />of the Food Vendor's Applications no later than two weeks prior to event <br />Average Age: 60