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Environmental Health Department <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: J 6Average Age:Approximate attendance at peak time: IDC>C)6. <br />1. <br />2. <br />3. <br />4. <br />35. <br />6. <br />APPLICATION <br />1. <br />2. <br />-a4/Event 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 $172 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />® Yes <br />S Yes <br />S Yes <br /> No <br /> No <br /> No <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/01/2024 <br />j'ynuzb PlhiLh.a ■ <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 />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $172 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 $774.00 <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 />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: <br />Name of sanitary garbage disposal company: /Number of dumpsters: <br />Method of disposal of liquid waste for food booths: AN i FA Ry /S/C <br />GENERAL EVENT FILE INFORMATION <br />- //)- J>l ,V/ <br />(Jut La/Im nP ___________________ <br />Date(s) of Event: |0 " l^' 'Ad ~~ //)-/Al T1'/ Time of Event: <br />Location: Al. filxif-L <br />Event Coordinator (Name): /UTURA Pc.KE.lRFl Telephone: (<^0^ T / A - <br />Mailing Address: ZJcRcUNF- Cf^ 95^/5 3-^ <br />Number of Food Booths: / ____________________________________________