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Environmental Health Department <br />Time of Event: 11ani-5pm2. <br />3. <br />4. <br />5. <br />35006.Total Attendance: <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />H-11'^Date:Event Coordinator: <br />2. <br />3. <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 S156 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> Yes <br />0 Yes <br />0 Yes <br />0 No <br /> No <br /> No <br />1868 E. Hazelton Avenue | St| <br />EHD 16-02 1 <br />06/19/19 <br />SAN JOAQUIN <br />------COUNTY------ <br />Grcotneis 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. <br />UTILITIES <br />1. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $156 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 $702.00 <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 />.kton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 1 ot 11 TEMP EVENT APP <br />Name of Event: L°di Comic Con <br />Date(s) of Event: Sunday, May 7, 2023 <br />Location: Lodi GraPe Festival <br />Event Coordinator (Name): Mike Millerick Telephone: ( 20R-471-5478 <br />Mailing Address: PQ RQX 7202 Stonktan CA 95267 <br />Number of Food Booths:6________ <br />Approximate attendance at peak time: 2000 <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:Number of toilets provided: w/ G P-^- <br />Name of sanitary garbage disposal company: /117 Number of dumpsters: L <br />Method of disposal of liquid waste for food booths: S' / In <br />Average Age: 20ish