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A <br />Environmental He <br />Freedom Fest <br />2.6pm - 9pmTime of Event: <br />3. <br />4.339 -7333Telephone: (209) <br />25. <br />6.1,5001,500 30Total Attendance:Average Age: <br />2. <br />3. <br />4. <br />5.Number of dumpsters:1 <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />Event Coordinator (Name): <br />Mailing Address: 11451 N West Lane , Lodi, Ca 9524 2 <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />w'‘lfe0UIN <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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $156 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 $702.00 <br />This application is to be completed and signed by the Event Coordinator, then returned to the Environmental <br />Health Department with all Food Vendor’s Applications no later than two weeks prior to the event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State standards <br />and the Environmental Health Department policies and procedures. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1.□ No <br />□ No <br />□ No <br />Waste Management <br />Method of disposal of liquid waste for food booths: Septic <br />0 Yes <br />0 Yes <br />0 Yes <br />/ T <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 j www.sjgov.org/ehd <br />EHD 16-02 Pagel of 11 ' TEMP EVENT APP <br />06/19/19 <br />fcOgnartment <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: 30 <br />Name of sanitary garbage disposal company: <br />Name of Event: <br />Date(s) of Event: June 29, 2025 <br />Location: The Home Church <br />Luke Pollock <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 $172 5 <br />c) Temporary Food Vendors Applications for each booth (( JJ <br />d) Temporary Event Site Plan Food - <br />e) Vendor List [/