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SANAAQUIN Environmental Health Department <br />--- Cs: UNTy <br /> <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: WI tint-frit Yeti,/ <br />Date(s) of Event: dailtiatj 022 RAV Time of Event: flair - Spi/V) <br />Location: 14;Orap6 regilVid 4/3 ti 1a St - biat, cti ,95-y--0 <br />Event Coordinator (Name): Ledli4 giver-AJ Telephone: (024 723 -q90 <br />Mailing Address: c,2B261 CM961(19 14.) S-i-ockg-tro, eifi 9 5---1.- <br />Number of Food Booths: /0 <br />Approximate attendance at peak time: 3 b 0 Total Attendance: 7 00 Average Age: <br />UTILITIES <br />Is potable water supplied and available for each food vendor: Yes 'El No <br />Is electricity supplied and available for each food vendor: ,Yes El No <br />Are janitorial facilities available: )2'Yes El No <br />Number of toilets provided: A-0 <br />Name of sanitary garbage disposal company: CIO 11141-S te/ Number of dumpsters: <br />Method of disposal of liquid waste for food booths: et/ij geA4/0> <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: <br /> <br />/1 A7/02 3 <br /> <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 />'11Z 094 <br />06/29/2023