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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />00 b6.Approximate attendance al peak time:Total Attendanci <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />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 $179 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed oy 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 />0Ves <br />EZfYes <br />0 Yes <br />ll T7| ----- <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Pagel of11 ' TEMP EVENT APP <br />07/0V2025 <br />SAN JOAQUIN <br />-COUNTY-- <br /> No <br /> No <br /> No <br />:e( logo <br />Number of dumpsters: <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 />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />__Average Age: <br />Ihrfnfi fvEKT <br /> Date(s) of Event: A\J S J" S' Time of Event: T0 T* <br />Location: MrU GMMuMTN JMflX . MAl^ST- frl, tym UT £ & <br />Event Coordinator (Name):Telephone: (^ofc Vo~7 8^1 ? <br />Mailing Address: A V-Fy 3J <br />Number of Food Booths:------ <br />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: f \Z~4LLpy <br />Method of disposal of liquid waste for food booths: