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Environmental Health Department <br />-i'fP.r--' <br />1. <br />2. <br />3.CA. <br />4. <br />5.5. <br />6.Approximate attendance at peak time: 75 Total Attendanci Average Aqe:0-89100 <br />UTILITIES <br />1. <br />2. <br />3. <br />4.1 1 <br />5.Number of dumpsters: 2 <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: Nov/17/2021 <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />KJ Yes <br />E Yes <br />E 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 />06/19/19 <br />9pm <br />1pm <br />95330 <br />_____Telephone: £09) 81 <-6730 <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 />• $152 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 $684.00 <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 />GENERAL EVENT FILE INFORMATION <br />Name of Event: Our Lady of Guadalupe Festivities <br />Date(s) of EventDecember 1 1-12, 2021 Time of EventSat 3pm <br />Sun 4amLocation:!6200 Cambridge Dr. Lathrop, ' <br />Event Coordinator (Name)Jose Carlos Flores <br />Mailing Address: <br />Number of Food Booths: <br />SANJOAOUIN <br />-COUNTY----- <br />Greatness grows here. <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: Republic Services <br />Method of disposal of liquid waste for food booths: Trash <br />Same as Above <br />Jose Carlos Fl ore s