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� y <br /> r�AN J 0 A QI l" Environmental Health Department <br /> COUNTY <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 /> GENERAL. EVENT FILE INFORMATION <br /> 1. Name of Event: Portuguese Traditional Pork Dinner, Crab Feed,Wisk Party, Steak&Oyster Dinner <br /> 2. Date(s)of Event: 7 0 22 4 12 2026 Time of Event:6:00 PM <br /> 3. Location: Our Lady of Fatima Society,26590 N.Sacramento Blvd.,Thornton,CA 95686 <br /> 4. Event Coordinator(Name): Leo VaSC0❑.QeJ0S Telephone:Z09) 361-2765 <br /> Mailing Address: 900 Jordine Way,Galt,CA 95632 <br /> 5. Number of Food Booths: No Food Booths. Food will be servied in the hall from the hall kitchen. <br /> 6. Approximate attendance at peak time: 450 Total Attendance: 650 Average Age: 55 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: 0 Yes ❑No <br /> 2. Is electricity supplied and available for each food vendor: n✓ Yes ❑No <br /> 3. Are janitorial facilities available: 0 Yes ❑No <br /> 4. Number of toilets provided: 15 in hall bathrooms. <br /> 5. Name of sanitary garbage disposal company: Cal Waste Number of dumpsters: 1 <br /> 6. Method of disposal of liquid waste for food booths: Dumped into kitchen sinks that drains into a grease trap_ <br /> APPLICATION <br /> 1. 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 /> 2. If the event is selected for inspection,the Event Coordinator will be billed for inspection time: <br /> Q $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 Califomia State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: Date: 12.12-225 <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EKD 1&02 Page 1 of 11 TEMP EVENT APP <br /> 07l0112025 <br /> R052Lf5gCJ <br />