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* j c. (|t>R<l)905u'5| <br />Environmental Health Department <br />Average Age: " H 5Total Attendance: & <br />Number of dumpsters: H Cmtc^S <br />APPLICATION <br />1. <br />2. <br />/? <br />Event Coordinator: <br />5. <br />6. <br /> No <br /> No <br /> No <br />iH^ealth Department two weeks prior to the event: <br />MDNf’P-OPtT ( 5"Olc3) <br />[Zf/es <br />H Yes <br />13 Yes <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: G> <br />Name of sanitary garbage disposal company: |^. Er PV S LI C> <br />Method of disposal of liquid waste for food booths: b i <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/01/2025 <br />TEMPORARY EVENT APPLICATION <br />o 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 />Submit the following to the Environmental <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 J <br />e) Food Vendor List <br />SAN JOAQUIN <br />— COUNTY------ <br />Greotness grows here. <br />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 />____ Date: 3" 13 T G <br />Name of Event: 51 T Z? M <br />Date(s) of Event: M ■ I X Tjme Qf Event: | £? 62C2 - \ Q, O D <br />Location: <br />Event Coordinator (Name):_S> Gi P | Cl Telephone- (itXf) <br />Mailing Address: Ml? S l2K)IC>Kl 5^ STK^Z <br />Number of Food Booths: C? " <br />Approximate attendance at peak time^S^OQ