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1 <br /> I P e­ohk, SANA QAQU IN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <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: jnaT a n aM <br /> 2. Date(s)of Event: 0� f 14/7 O L 5 l Time of Event: ,� n n <br /> `75 <br /> 3. Location: 1 �0 r_ 1_✓�1OodwgyD AVE ILNWeCa,C, 3 37 <br /> fT 4. Event Coordinator(Name): M ay 3 i+ S;n 91 Telephone::1H j j) �1d — 0101 <br /> Mailing Address: �p � 1, D{Canaey Ayf /Ma,4eca _ �� 'fs 37 <br /> 5. Number of Food Booths: 2 <br /> 6. Approximate attendance at peak time: ^Od FM Total Attendance: SQQ Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Ryes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ["Yes ❑ No <br /> 3. Are janitorial facilities available: [�Yes ❑ No <br /> nn <br /> 4. Number of toilets provided: — 2 V <br /> 5. Name of sanitary garbage disposal company: M.,j a cf J wr L a 9 e Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: ,( b Q <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$172 <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 /> • $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 /> Event Coordinator: Date: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07101/2024 <br />