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IP(ZOS3>MSH3 <br />Environmental Health Department <br />Name of Event. <br />2. <br />3. <br />4. <br />5. <br />6. <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2 <br />Date. Event Coordinator: <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: <br />Method of disposal of liquid waste for food booths: <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 $179 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />1868 E Hazelton Avenue-1 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 />07/01/2025 <br />SAW JOAQUIN <br />— COUNTY <br />^Yes <br />■gives <br />IJlYes <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $179 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 $805.50 <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 />t Quorx-e <br />Telephone: (1 — Of <br />fiA Po <br />ISO <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, (hen returned Io the Environmental Health Department with all <br />of the Food Vendor's Applications no later than two weeks prior to event <br />S 4^ <0. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />hoop <br /> Average Age. Approximate attendance at peak time: 1 Total Attendance: <br />_ / (jit L'p I. i ______________________ <br />Date(s) of Event: ' l?> ~ J 6^ __ Time of Event: byJL <br />Location: A1 l/o. ku VC oV- <br />Event Coordinator (Name): /V\rrV\ I-CuvtH <br />Mailing Address: _L5L).-S S ■ <br />Number of Food Booths: -c / J / < j I <br />ISO