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4 <br />11 grollel!">. <br />SAN1410AQUIN co U N <br />Great nes s qtlwic <br />I3V 0 50,4924) t <br />Environmental Health Department <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departmen <br />'ArlvilioAlm I 2°24 <br />7././ <br />11-:00 <br />t'Cl77.1 3?(_12 <br />Mailing Address: <br />Number of Food Booths: rj <br />Approximate attendance at peak time: 970eX7Total Attendance: 1 1000 Average Age: 504- 0 <br />UTILITIES <br />Is potable water supplied and available for each food vendor: Yes 111 No <br />Is electricity supplied and available for each food vendor: IR Yes Li No <br />Are janitorial facilities available: Yes El No <br />Number of toilets provided: IS <br />Name of sanitary garbage disposal company: Ci f-IP)6.71.61A Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />APPLICATION <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 $162 <br />C) Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />$162 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 $729.00 <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 />Event Coordinator Date: <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I wvvw.sjgov.orgiehd <br />END 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023 <br />of the Food <br />GENERAL EVENT_EILE/INFTIpN <br />Vendor's Applications no later than two weeks prior to event <br />1. Name of Event: r-etS4A- <br />Date(s) of Event: <br />Location: L <br />1 Time of Event: <br />C r-Art)liAAL, <br />Event Coordinator (Name): r--' Ak& Tqlephone.6Zq <br />414y