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SAN JOAQUIN Department fP Environmental Health De <br /> COUNTY— <br /> ` 4 <br /> Greatness grows here. <br /> Mq <br /> TEMPORARY EVENT APPLICATIOWN?/,Roy R14 n� QD <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health nt p?lf all <br /> of the Food Vendor's Applications no later than two weeks prior to event �SFR y,�Ty <br /> GENERAL EVENT FILE INFORMATION ' <br /> 1. Name of Event: �kr• � 7pamgLc kcal sz <br /> 2. Date(s) of Event: - Time of Event: ci Am -- DM <br /> 3. Location: S• U MO n h J-4 K%M AyA "r V�0,tnE,_ p, C.A <br /> 4, Event Coordinator(Name): ugjs 1.rt p. , Telephone: (),49 q05 34,14 <br /> Mailing Address: LAWA <br /> 5. Number of Food Booths: jO <br /> 6. Approximate attendance at peak time: 9Q�0 Total Attendance: Sop Average Age: <br /> UTILITIES <br /> 1. is potable water supplied and available for each food vendor: ❑ Yes [Sofo <br /> 2. is electricity supplied and available for each food vendor: ❑ Yes (�o <br /> 3. Are janitorial facilities available: ❑ Yes MNo <br /> 4. Number of toilets provided: �- <br /> 5. Name of sanitary garbage disposal company: S�f--1 Number of dumpsters: I <br /> 6. Method of disposal of liquid waste for food booths: Z�, >� <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 ( T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> ENO 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/0112024 <br />