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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5.as/OD 3006.Approximate attendance at peak time:Average Age:Total Attendance: <br />1. <br />2. <br />3. <br />84. <br />/5. <br />6. <br />APPLICATION <br />1. <br />FEB 2 3 2024 <br />2. <br />Date: <br />environmental health <br />DEPARTMENT <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 Environmental Health Department policies and procedures. <br />Event Coordinator: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 . 1 ■. Pagel of 11 , TEMP EVENT APP <br />06/29/2023 <br />KI Yes No <br />Yes No <br />*0 Yes No <br />GENERAL EVENT FILE INFORMATION <br />1. <br />.5 rxt*SAN JOAQUIN <br />------COUNTY------- <br />Greatness □rows here. <br />Submit the following to the Environmental Health Department two weeks prior to thJ^BnC-EI VED <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 />UTILITIES <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:H > t <br />Name of sanitary garbage disposal company: QUL'tlC.C' -Mfyi VSOTiClHNumber of dumpsters: <br />Method of disposal of liquid waste for food booths: adders <br />__________ON • . <br />Spring <br />Date(s) of Event: HcircJn Aprils _Time of Event:. tUMm - m prri <br />Location: &Q.SS Pro Dr ttadfCO, 95337_________ <br />Event Coordinator (Name): SOM MdlCkllh Telephone:^? I b <br />Mailing Address: /3>a3o £.434^ Dr Murm Az 2S3M7 <br />Number of Food Booths: I