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Environmental Health Department <br />1.Name of Event: <br />2. <br />3. <br />)4. <br />5. <br />10-20 per d^erage Age; 4056.Approximate attendance at peak time:Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3.N/A <br />4. <br />N/A5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />8/4/23Event Coordinator: Date: <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 $162 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Date(s) of Event: <br />Location: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />06/29/2023 <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 />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: 1 inside building <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />N/A <br />N/A <br />ESI Yes <br />' Yes <br />□ No <br />O No <br />!Z] No <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 />SAN JOAQUIN <br />-COUNTY— <br />Greatness grows here. <br />[X] yes <br />GENERAL EVENT FILE INFORMATION <br />Prime House Direct Truckload Meat Sale <br />August 30-Sept 3 (Manteca 9/6-9)rime of Event: S'7 <br />3360 McHenry Ave, Escalon, CA Manteca Sept 6-9 location tbd <br />Event Coordinator (Name): Johnsie Nelson/Harry Peaden Telephone: ( 1 904-217-9427 <br />Mailing Address: 10 Celebration Way, Peachtree City, GA 30269 <br />Number of Food Booths: