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?(2_O 54^o=f3 <br />Environmental Health Department <br />3<DAverage Age: <br />1. <br />2. <br />Date: <br />5. <br />6. <br />a) <br />b) <br />c) <br />d) <br />e) <br />Io <br />□PKlo <br /> No <br />SAN JOAQUIN <br />- COUNTY---- <br />Greatness ^rons h€<e <br /> Yes H'N. <br /> Yes <br />E^fes <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Number of dumpsters: <br />(’JteWltP/AL <br />Total Attendance: <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 />Event Coordinator: <br />FY o o -2-M I 42 <br />Oate(s) of Event: Time of Event: ~Y <br />Location: 5- bAftlM 6T, } I_____ <br />Event Coordinator (Name): ’Prill IrlA f4COcO __Telephone: (^>1 '^14'1 <br />Mailing Address: Pflft ; 6 -TAHQg, CA Qfobt <br />Number of Food Booths: 2^ <br />Approximate attendance at peak time: <br />APPLICATION <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $179 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <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 ba complatad and signed by the Event Coordinator, then "turned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two pripr fo the <br />? 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 />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^g/ehd <br />EHD 16-02 Ptoeiofii <br />07/01/2025 <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: t ) <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: