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AUG 0 6 2026 <br />Environmental HealtWMW^^tiVient <br />! <br />Average Age: Total Attendance: <br />3Number of dumpsters: <br />I <br />APPLICATION <br />1. <br />I <br />2. <br />Date: Event Coordinator: <br />f <br />f^OSHWi) <br /> No <br /> No <br /> No3. <br />4. <br />5. <br />6. <br />2. <br />3. <br />4. <br />5. <br />6. <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 v/aste for food booths: <br />I <br />! > <br />II <br />I <br />$I <br />TEMPC <br />To be completed and signed by Evie <br />of the Food Vet <br />SANJ0A0UIN <br />-----COUNTY----- <br />ij/ri'tness ■ytows here. <br />I! <br />I <br />j <br />■■ <br />■ <br />i <br />ii <br />> <br />.O.g I._ <br />YjEVENT APPLICATION <br />jSfcaJbr/then returned to the Environmental Health Department with all <br />'Applications no later than two weeks prior to event <br />,cr <br />ion time: <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />2. <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Appircdtidn 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 />If the event is selected for inspection, the Event Coordinator will be billed for ins] <br />• 3179 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 Wealth Department policies and procedures. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 18-02 P090 1 Of 11 TEMP EVENT APP <br />07/01/2025 <br />[^fYes <br />fjQYes <br />E^Yes <br />Name of Event: foX <br />Date(s) of Event: $7 /) <br />Location: <br />Event Coordinator (Name): /VXak <br />Mailing Address: _j <br />Number of Food Booths: X <br />Approximate attendance at peak time: <br />.......urowAi iun f p. 1 <br />/ Tax <br />’ Time of Event: ,• yy ___ <br />Tr'.b.^- rTx7>/\(’r' _ Telephone: — <br />Ar/7rT7^.i .A4-