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Environmental Health Department <br />1.Name of Event: <br />2. <br />3. <br />4.Telephone: (209)471 6891 <br />55. <br />400 600 456.Approximate attendance at peak time:Total Attendance:Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />1Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />-23> -ZMDate:Event Coordinate <br />IO <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Date(s) of Event: <br />Location: _____ <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: <br />[x] Yes <br />H Yes <br />QYes <br />□ No <br />□ No <br />□ No <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />07/3/17 <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 />Debbie Murken <br />PO Box 222 Escalon Ca, 95320 <br />December 7th, 2024 Time of Event:3pm to 8pm <br />1771 Main Street Escalon, ca 95320 <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($228 per hour) <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 />Gilton <br />Buckets for runoff <br />GENERAL EVENT FILE INFORMATION <br />Christmas on Main <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <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 />5 <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: