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I <br />Environmental Health Department <br />1 o 2. $ Name of Event. <br />41^)4 <br />5002.00 Average Ag, <br />1 <br />APPLICATION <br />1. <br />2. <br />VUm/h, 0^/Date:Event Coordinator: <br />2 <br />PlCLP <br />4. <br />5. <br />6 <br />5. <br />6. <br />V4ASTE <br />Number of dumpsters: <br /> No <br /> No <br /> No <br />SAN JOAQUIN <br />-COUNTY- <br />[vfYes <br />H^Yes <br />□TYes <br />2- "5 . <br />pYOYYY5b2 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 164)2 Pa9° TEMP EVENT APP <br />08/29/2023 <br />^/Total Attendance: <br />\ <br />UTILITIES <br />1. <br />2. <br />3 <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <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 />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 $162 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time <br />• $162 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 $729.00 <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. . , 1 <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 />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: <br />Name of sanitary garbage disposal company: DG’L.lA <br />Method of disposal of liquid waste for food booths: <br />Date(s) of Event ’Hftnh 2 Time of Event D A <br />Location TaAl PlgLP 7“ <br />Event Coordinator (Name) P* IS HDA *-Telephone. ( <br />Mailing Address: poj; h yYM V ------------------- <br />Number of Food Booths: <br />Approximate attendance at peak time'.