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S A N J O A Q U I N Environmental Health Department <br /> — C O U N T Y----- <br /> Grearness 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: e' 'V/LA4 fG l W i'ry5 ��'y���G#r' �ie il'✓ <br /> 2. Date(s)of Event: otir S 4 Time of Event: jV of Ai',\ — j7 00 P f- <br /> 3. Location: � JU' �J7✓ 1^^At'rb��� yt1;�"fh Its I S eArO1t ", mpt- erA S- W15 <br /> 4. Event Coordinator(Name): iK�St, 9A'0l/L� Telephone: ( )�� �' 2 <br /> Mailing Address: P-J, <br /> 5. Number of Food Booths: 3 <br /> 6. Approximate attendance at peak time: D v,3v Total Attendance: K J� Average Age: f J <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes [RiNo <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes ;9 No <br /> 3. Are janitorial facilities available: ❑ Yes N No <br /> 4. Number of toilets provided: A_ <br /> 5. Name of sanitary garbage disposal company: /a,�'f�G�! �a�/✓ Ire Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: A,,il1r-) <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: !M <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 /> 07/01/2024 <br />