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SANJOAQUIN <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: 0 HOW 0 HVGV-LeS (51217 L-6-4.-Ac,-1' we- Lop! le.(cr-14) <br />Date(s) of Event: 1/ /3 lo-q Time of Event: 41: DO A1,11 <br />Location: 41 q13 g- tvila--6 64-otie <br />Event Coordinator (Name): 9A-04i3O (urni.,6-- Telephone: 6.01 v7-4- qc t so <br />Mailing Address: -6 2-42- 1,i) • 11A(2412 po• u._00( l aik ercaq 0 <br />Number of Food Booths: 12- <br />Approximate attendance at peak time: 1-513 Total Attendance: /1()0 Average Age: 4o1.5. <br />UTILITIES <br />Is potable water supplied and available for each food vendor: 13-1-'-e-3 0 No <br />Is electricity supplied and available for each food vendor: 21-e-s 0 No <br />Are janitorial facilities available: jafe-s 0 No <br />Number of toilets provided: c7(.,4A9kc S 11100443 avor ler6le <br />Name of sanitary garbage disposal company: Number of dumpsters: 3 <br />Method of disposal of liquid waste for food booths: clu+kvp04-CCC <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: 107/20/2-g <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 <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />ViZattoock,v5 06/29/2023