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-RECEIVED <br />SAN JOAQUIN <br />CO U N — <br />JUN 24 2024 <br />Environmental Helitikilit(RIAmtufwAmpir <br />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 />Freedom Fest 1. Name of Event: <br />Date(s) of Event: June 30, 2024 Time of Event: 6pm - 9pm <br />Location: The Home Church <br />Event Coordinator (Name): Luke Pollock Telephone: (209) 339-7333 <br />Mailing Address: 11451 N West Lane, Lodi, Ca 95242 <br />Number of Food Booths: 2 <br />Approximate attendance at peak time: 1,500 Total Attendance: 1,500 Average Age: 30 <br />UTILITIES <br />Is potable water supplied and available for each food vendor: Yes 0 No <br />Is electricity supplied and available for each food vendor: VI Yes 0 No <br />Are janitorial facilities available: V Yes 0 No <br />Number of toilets provided: 30 <br />Name of sanitary garbage disposal company: Waste Management Number of dumpsters: 1 <br />Method of disposal of liquid waste for food booths: <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 />Septic <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 vvww.sjgov.orgtehd <br />END 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19