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Environmental Health Department <br />Time of Event: Sat 11am -9pm Sun Noon to 6pm <br />_Telephone: (209 ) 487-3042 <br />Total Attendance:2000 Average Age: 35 <br />Number of dumpsters: <br />APPLICATION <br />1. <br />2. <br />8 - IT• £02Date: <br />NOTICE TO ALL TEMPORARY EVENT COORDINATORS <br />California Retail Food Code (CalCode) Section 113755 defines “Temporary Food Facilities” as a food <br />facility approved by the enforcement officer that may be readily disassembled for storage or for <br />transporting, and readily assembled to its original integrity at a different location, is easily movable, and <br />operates at a fixed location for the duration of an approved community event or at a swap meet. <br />XD Yes <br />XD Yes <br />XD Yes <br />□ No <br />□ No <br />□ No <br />5. <br />6. <br />Name of Event: Stockton Community Powwow <br />Date(s) of Event: Sept. 5th and 6th <br />Location: University of the Pacific <br />Event Coordinator (Name):Destiny Rivas <br />Mailing Address: 2017 Lucerne Ave Stockton CA 95203 <br />Number of Food Booths: Site <br />Approximate attendance at peak time:300 <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 12 TEMP EVENT APP <br />07/01/2025 . <br />j sc? sLrtflWsj), PiT os oTTSS <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 />SAN JOAQUIN <br />-COUNTY— <br />Greotness grows here. <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: 16 <br />Name of sanitary garbage disposal company: UOP Facilities <br />Method of disposal of liquid waste for food booths: Containers <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 Environmental <br />Health Department with all Food Vendor’s Applications no later than two weeks prior to the event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State standards <br />and the Environmental Health Department policies and procedures. <br />Event CoordinatorfY^^—^21^ <br />GENERAL EVENT FILE IN FORMAT ION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6.