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<br />OS 29 Sgri <br />SANIJOAQUIN <br />COUNTY <br />Greatness grows here <br />Environmental Health Department <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 />Name of Event: (Li k <br />( <br />rn , , <br />Date(s) of Event: 10 1Y - 4,9 — - :),LI Time of Event: ,9i1-1 <br />Location: 2L 5 Y AI. (1_ 4--C Ci4 <br />Event Coordinator (Name): LaLl PE----RE-ikA Telephone: (Ac) - <br />Mailing Address: Ci JLRtit'i-JE. 6 A-1_ ci5L <br />Number of Food Booths: <br />Approximate attendance at peak time: /OCC Total Attendance: Average Age: 46 <br />UTILITIES <br />Is potable water supplied and available for each food vendor: L Yes LI No <br />Is electricity supplied and available for each food vendor: BA Yes LII No <br />Are janitorial facilities available: [A Yes LI No <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: ificif-;11:, Number of dumpsters: <br />Method of disposal of liquid waste for food booths: tfi at( ,=-3c <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 $172 <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 />$172 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 $774.00 <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: LLA el. PLILLIA Date: <br />1868 E. Hazelton Avenue I Stockton. California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/01/2024