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P �_o ­�� z--s <br /> DocuSign Envelope ID:3DC34B1A-8A8B-4828-9F43-5BD6B9BCCABO <br /> Fr- oo <br /> SA N.J OAQ U I N Environmental Health Department <br /> COUNTY <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 /> 1. Name of Event: Music in the Park <br /> 2. Date(s)of Event: May 18, 2024 Time of Event:6:00-9,00pm <br /> 3. Location: Central Community Park, Mountain House <br /> 4. Event Coordinator(Name): Laura Johnston Telephone: (209) 831-5668 <br /> Mailing Address: 2T_. Main Street, Mountain House, CA 95391 <br /> 5. Number of Food Booths: 11 - <br /> 6. Approximate attendance at peak time: 750 Total Attendan 1,000 Average Ag 0 <br /> UTILITIES 2 1P <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes ® No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes ❑x No <br /> 3. Are janitorial facilities available: ❑ Yes ❑x No <br /> 4. Number of toilets provided: 5 <br /> 5. Name of sanitary garbage disposal company: West Valley Disposable Number of dumpsters: 1 <br /> 6. Method of disposal of liquid waste for food booths: ve❑a..must take with sheet <br /> APPLICATION <br /> 1. Submit the following to the Environmental Health Department two weeks prior to the event: <br /> a) Temporary Event Application <br /> b) Application Review Fee of$162 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) 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 he 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 /> 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 /> J-D1ocluuSignedby: <br /> Event Coordinator: Date: 4/28/2024 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 0612912023 <br />