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Q4 U Environmental Health <br /> _SAN , O� <br /> C(--"'i t , <br /> 1t4)2,� <br /> TEMPORARY EVENT tor,then eAPPLICATION Healthd to the Environmental Department with all <br /> of the Food Vendor'sAp <br /> To be completed and signed Event is Appnacations no later than two weeks prior to event <br /> GENERAL EVENT FILE INFO'RM�N <br /> 1. Name of Event: ou R"P' P(I—Tk— <br /> 202�1 Time of Event: 10 P1 _ t o PM <br /> 2. Date(s)of Event: 6C'I�be `I - � G C1� 5�-7 1 <br /> �E �GZ t ipt�tTl✓ <br /> 3. Location: �� � C� ' __ � <br /> 4. Event Coordinator(Name): c> � ��_YVKQ� Telephone: (46N �+3r3 4g�t <br /> Mailing Address: <br /> 5_ Number of Food Booths: 25 <br /> 6. Approximate attendance at peak time: <br /> ©Q Total Attendance: 2=Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [9'Yes ❑No <br /> 2. Is electricity supplied and available for each food vendor: 0 Yes ❑ No <br /> 3. Are janitorial facilities available: �C �,�;�� • G1�1'Yes ❑ No <br /> 4. Number of toilets provided:_ '2. � gin �e wr - (�(�xM( <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <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 5:0o 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: ti� 1AY Date: <br /> 1868 E. Hazefton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 1 wb+rvv.sjgov_org/ehd <br /> EHD Page 1 of 11 <br /> 07/01/2024 2024 9 TEMP EVENT APP <br />