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S A N J O A Q U I N Environmental Health Department <br /> LU 6.64, -----COUNT Y__ <br /> + c " Greatness grows her, <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 /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: L <br /> --�(kV'\ <br /> 2. Date(s) of Event: r� Lid ' L 0) Time of Event: rJ�11'1 <br /> 3. Location: QAZL Alk&'k U !y'\ <br /> 4. Event Coordinator(Name): l.(k ~_S Telephone: 30(1_ <br /> Mailing Address: _ �Q h 5" GiC.i f� rj� •k 22 r <br /> 5. Number of Food Booths: in <br /> 6. Approximate attendance at peak time: !2 Oa Total Attendance: 5��� Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [�Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: E?Yes ❑ No <br /> 3. Are janitorial facilities available: [ -Yes ❑ No <br /> 4. Number of toilets provided: � �\C <br /> 5. Name of sanitary garbage disposal company: v,.rti'\ - ;i Mjlc Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: J h 1_\AC Vr(!` '}?i�1 �j t1�L <br /> APPLICATION <br /> 1. 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 /> 2. 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 6:00 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: LZ <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 J www.sigov.org/ehd <br /> EHD 16-02 Pagel of 11 TEMP EVENT APP <br /> 06/29/2023 <br />