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N MOWN Environmental Health De <br /> Ott <br /> 0 2.14 � <br /> TEMPORARY EVENT APPLICATION <br /> To be completed and signed by Event/ oCoorrdinator,the no tome later hao two weeks the mentalprior to ealtt Department with all <br /> of the Food Applications <br /> GENERAL EVENT FILE I_RM_ION <br /> 1. Name of Event: _DU R :S P U3 <br /> 2. Date(s) of Event: IJC roM Z 4y.�-- C-4C '20'Z`i Time of Event: lC�1 tv� t pf�� <br /> 3. Location: �c� G(�` �Q �i 36 _E4�� <br /> C>pt�lLy4 p, tom`j�Z= Telephone: (r 15W <br /> 4. Event Coordinator(Name):_ <br /> Mailing Address-, <br /> 5. Number of Food Booths: g �5 <br /> 6. Approximate attendance at peak time: e) UO Total Attendance: '2�� Avera e Age: <br /> UTILITIES <br /> 1. is potable water supplied and available for each food vendor: 0 Yes ❑ No <br /> 2. Is electricity supplied and ave ilable for each food vendor: Yes ❑ No <br /> 3. Are janitorial facilities available: �,� i� Yes ❑ No <br /> 4. Number of toilets provided: _ <br /> 5. Name of sanitary garbage di.-posal 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 F,pplication <br /> b) Application Review Fee of$172 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event"lite 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: �' .11 L^, -0 Date: <br /> 1868 E. Hazetton Avenue i Stockton. California 95205 � T 20g EHD 16-02 468-3420 F 209 464-0138 j vnrrr.sjaov.orq/ehd 07/01/2024 Pagel of 11 <br /> TEMP EVENT APP <br />