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I <br />t. SANAOAQUIN <br />`1 —COUNTY .t <br />,siLipoc0/ Greatness r;nws h e r j, <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: 0 140 0 4 cHucte-Les (3RD Lfk-AcY 1,4e- Lop' <br />Date(s) of Event: 0/3 /94 Time of Event: 41 100 A-0 <br />Location: ilq-13 1(- mia--6 64oilf rep <br />Event Coordinator (Name): 9A-04v3 Telephone: 601 V7-4- qq-ao <br />Mailing Address: -6 242- i.A) • 1U24,44512 PO • 1.,._0(7 ( CA 6:7C-Q-'-i <br />Number of Food Booths: 12- <br />Approximate attendance at peak time: 1.5-0 Total Attendance: 1CO Average Age: PNI 41t_. <br /> <br />UTILITIES <br />Is potable water supplied and available for each food vendor: lale-s LI No <br />Is electricity supplied and available for each food vendor: afe's 0 No <br />Are janitorial facilities available: .1,7Ks 0 No <br />Number of toilets provided: ?(A ICC ‘r. CS '11b0 w1-5 avo( <br />Name of sanitary garbage disposal company: PA-12-r--& Number of dumpsters: 3 <br />Method of disposal of liquid waste for food booths: clikt•vpk-i-CrC <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 $162 <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 />$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: Yo2o/t2A) <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd END 16-02 Page 1 of 11 TEMP EVENT APP 06/29/2023