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P (2- C) <S �-A q-4 <br /> 0o z� � ,�� <br /> S A N J U A Q U I N Environmental Health Department <br /> COUNTY <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: Juneteenth Celebration <br /> 2. Date(s) of Event: June 20, 2026 Time of Event:3:00-9:00pm <br /> 3. Location: Central Community Park, Mountain House <br /> 4. Event Coordinator(Name):Laura Johnston Telephone: ( ) 209-831-5668 <br /> Mailing Address: 251 E Main Street, Mountain House, CA 95391 <br /> 5. Number of Food Booths: 12 <br /> 6. Approximate attendance at peak time: 1,000 Total Attendant 1,500 Average Age: 40 <br /> UTILITIES 2 ` <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes W No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes ❑ No <br /> 3. Are janitorial facilities available: ❑ Yes ❑ No <br /> 4. Number of toilets provided: 5 <br /> 5. Name of sanitary garbage disposal company: West Valley Disposable Number of dumpsters: 1 <br /> 6. Method of disposal of liquid waste for food booths: vendam will take with them <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$162 <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 /> • $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. <br /> 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: Laura Johnston Date: 6/1/27 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 [ T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT ARP <br /> 06129/2023 <br />