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Event Coordinator: <br />D <br />Environmental H RFCEIVEeaitn Department <br />MAY 1 5 2023 <br />1:.NVIRON1EN1AL HEALTH <br />DEM RTN1 ENT <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 />GENERAL EVENT FILE INFORMATION <br />Date(s) of Event: (7/e;,te Time of Event: //iii <br />Location: ,23' fi / 1 <br />Event Coordinator (Name): "ijij _Ali' itfr.,--p,e Telephone: (74)-4r 9715- <br />Mailing Address: „2/d,,t jidcf/Wir 4/7(1/7W <br />Number of Food Booths: t 5- <br />Approximate attendance at peak time: Total Attendance Average Age <br />UTILITIES <br />Is potable water supplied and available for each food vendor: 0 Yes No <br />Is electricity supplied and available for each food vendor: D-4 Yes 111 No <br />Are janitorial facilities available: Z1 Yes El No <br />Number of toilets provided: (3:26' <br />Name of sanitary garbage disposal company: /AV ket/e7/ <br />Method of disposal of liquid waste for food booths: (ie/ed4 lanyS <br />APPLICATION <br /> <br />1. Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $156 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br /> <br />2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />$156 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 $702.00 <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 />SAN JOAQUIN <br />- 0,4 <br />.•14FOV- <br />—COU NTY— <br />Greatness grows here. <br />1. Name of Event: <br />Number of dumpsters: e <br />Date: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19