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GENERAL EVENT FILE INFORMATION <br />Name of Event:1. <br />2:00 pm2. <br />3. <br />Claudia E. Barrientos 214-7198Telephone: (916)4. <br />10 Food Booths and 3 bars.5. <br />1000 1500 30Total Attendance:Approximate attendance at peak time:Average Age:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />25. <br />6. <br />APPLICATION <br />1. <br />2. <br />ironmental H <br />05/26/26Date:Event Coordinator: <br />TEMP EVENT APPPage 1 of 11 <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 />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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />poordinator, I am responsible for meeting California State <br />Apartment policies and procedures. <br />Q Yes <br />□ Yes <br />Q Yes <br />□ No <br />Q No <br />□ No <br />EHD 16-02 <br />nR/m/iR <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <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 />Jaripeo Baile <br />06/28/26 <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($208.50 per hour) <br />■' 'T' <br />I understand that as a temporary event <br />standards and the Environmental Hef^lth D <br />Event Coordinator (Name):. <br />Mailing Address: 610 Coleman Ave. San Jose, Ca. 95110 <br />Number of Food Booths: <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: 30 <br />Name of sanitary garbage disposal company: Contracted with Clements Number of dumpsters: <br />Method of disposal of liquid waste for food booths: Assigned area at the cook shack <br />Date(s) of Event: Time of Event: <br />Location- Clements Buckaroos 19813 CA 88 Clements, Ca. 95227