Laserfiche WebLink
DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />f 't <br />in to tfeek <br />aliSt.dr ) <br />"•:Infpoia7-' <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here. <br />Event Coordinator (Name): Laura Johnston <br /> <br />Telephone: ( ) 209-831-5668 <br /> <br />Mailing Address: 251 <br />Number of Food Booth <br />in Street, Mountain House, CA 95391 <br />11 <br />Approximate attendance at peak time: 2,000 Total Attendan e 2,500 Average Ag <br />UTILITIES ()) <br />PP -ocic) <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: Independence Day Celebration <br />July 4, 2024 Date(s) of Event: <br /> <br />Time of Event: 10:00am-2:00pm <br /> <br />Location: Central Community Park, 25 E Main Street, Mountain House, CA 95391 <br /> Is potable water supplied and available for each food vendor: E Yes 2 No <br /> Is electricity supplied and available for each food vendor: LII Yes RI No <br /> Are janitorial facilities available: Yes EI No <br /> Number of toilets provided: 6 <br /> Name of sanitary garbage disposal company: West Valley Disposable Number of dumpsters: 1 <br /> Method of disposal of liquid waste for food booths: vendors will take with them <br />APPLICATION <br />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 />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 />DocuSIgnitd by: <br />(Aura jelaotek. 6/18/2024 Event Coordinator: 031F2E71589CC482 Date: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I vvww.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/29/2023