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• - r <br /> •�Ur:t . <br /> `- 5 A N.�J OA Q U I N Environmental Health Department <br /> fry C O U N T-Y <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: � C a_*W <br /> 2. Date(s)of Event: P.(_p!tY1 Y1Pk (� 2,{] Time of Event: qVry,,% <br /> 3. Location: <br /> 4. Event Coordinator(Name): Telephone: (Zdl) ,�kc Lo 'JLPS'] <br /> Mailing Address: a!-y-% • d <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time, 1 9 0 Total Attendance: ( 6 ad Average Age: ct,1t Gq<;�`s <br /> UTILITIES �J <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes lff No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes PrN0 <br /> 3. Are janitorial facilities available: ❑ Yes No <br /> 4. Number of toilets provided: ^ wvstCLQ, 2Ct5 GVUeNV%,un-7� <br /> 5. Name of sanitary garbage disposal company:C1TT��Yt�G[�G.- Number of dumpsters: 2- <br /> 6. Method of disposal of liquid waste for food booths: _ 1� <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$179 <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 /> • $179 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$805.50 <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: Dater31 Z 02�� <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> EHD 1"2 Page 1 of 11 TEMP EVENT APP <br /> 07/01/2025 <br />