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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />22 100Total Attendance:Approximate attendance at peak time:6. <br />2. <br />3. <br />4. <br />Th Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <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 /> No <br /> No <br /> No <br />ii ^77 y CArQ ______________________ <br />-Telephone: (im) S <br />[3zYes <br />E&Ves <br />[pT'es <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 />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 />I understand that as a temporary event coordinator I am responsible for meeting California State <br />standards and the Envirpnmental Health Department [policies and procedures. <br />4/n <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023 <br />UTILITIES <br />1. <br />SAN JOAQUIN <br />-----COUNTY----- <br />Greatness grows here. <br />__Average Age: <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:J <br />Method of disposal of liquid waste for food booths: <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: a/ t\i\ e.y ''_______ <br />Date(s) of Event: of Event: <br />Location: / i. <br />Event Coordinator (Name): K./ <br />Mailing Address: ll / r, <br />Number of Food Booths: /