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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />as/DO 3006.Approximate attendance at peak time:Total Attendance:Average Age: <br />UTILITIES <br />1. <br />2. <br />3.84. <br />5. <br />6. <br />APPLICATION <br />1. <br />FEB 2 3 2024 <br />2. <br />Date: <br />Date(s) of Event: <br />Location: I <br />ENV IRONMENTAL 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 />buHeraryvilsti-rnm Vs > <br />® Yes No <br />Yes No <br />*0 Yes No <br />GENERAL EVENT FILE INFORMATION <br />1. <br />SAN JOAQUIN <br />-----(2 O U N I Y------ <br />Greatness -srows .bere. <br />ILL INFORMA1 ION • . <br />Spring fitrnivaJ__________________ <br />_Time of Event: NOM! - ID prr> <br />m-bU feassProfbr Han-kca 95337 <br />Event Coordinator (Name): SftlW LULCAoLIA Telephone^^Q <br />Mailing Address: /aaso LbSAFDr Muim Az. 2S36,? <br />Number of Food Booths: I <br />Submit the following to the Environmental Health Department two weeks prior to thJ^vEbC'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 />Y.- <br />jSTwL... <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 />Numberof toilets provided:S . i <br />Name of sanitary garbage disposal company:fiujilt.C^■AnnUSCfAdTlNumber of dumpsters: / <br />Method of disposal of liquid waste for food booths: b\ adders <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: Date: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 , J Pagel of 11 , TEMP EVENT APP <br />06/29/2023