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SA N J OAQ U I N Environmental Health Department <br /> —COUNTY <br /> Greatness 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. Name of Event: <br /> 2. Date(s) of Event: Time of Event: am — :Jaw <br /> 3. Location: (hL <br /> /� Ve <br /> 4. Event Coordinator(Name): (,�� �I S Telephone: (704 666 66 <br /> a r r—o 7 <br /> Mailing Address: (p 3 3 3��&L,I AC +V-e, 4 .5`p 1 v r-P+0n C,* 9saOD <br /> d5. Number of Food Booths: `/ <br /> 6. Approximate attendance at peak time: !7M Total Attendance: (on p Average Age: :3� O <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 LL <br /> 4. Number of toilets provided: mGnn f,nn T <br /> 5. Name of sanitary garbage disposal company: - ,� Numbelr�of dumpsters: ! �/ <br /> 6. Method of disposal of liquid waste for food booths: a �p,/1 v <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: /z-2-/2f� <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 /> 06/29/2023 <br />