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S A N J OA Q U I N Environmental Health Department <br /> TEMPORARY EVENT APPLICATION AQ� <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health Depa merit ftia <br /> of the Food Vendor's Applications no later than two weeks prior to event MAY <br /> FrvVl Zpzy <br /> GENERAL EVENT NFO ATI N p RMMSFTaC,y - <br /> ly <br /> 1. Name of Event: GL 4VICF'9 <br /> 2. Date(s) of E ent: - l Time of E nt. <br /> 3. Location: <br /> 4. Event Coordinator (Name): A T leph ne � <br /> Mailing Address: LA21Wr <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: fotal Attendance: l Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ,�Yes ❑ 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: 15 <br /> 5. Name of sanitary garbage disposal company: 16 EDF)CJILC 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$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 /> 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: Date: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16.02 Page 1 of 11 TEMP EVENT APP <br /> 06/2912023 <br />