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\\ <br />Environmental Health Department <br />1.Name of Event: <br />1630 -2200 PDT2. <br />3. <br />4. <br />5. 6.MoApproximate attendance at peak time: <br />UTILITIES <br />Number of dumpsters: 30YD <br />APPLICATION <br />2. <br />FRI. 10/24/2025Date:Event Coordinator: <br />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 />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 />AverageAge: <br /> No <br /> No <br /> No <br />BSt/esEJes <br />Raes <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 />Thisapplicationis tobecompleted andsignedby theEventCoordinator, then returnedto the Environmental Health <br />Department with all Food Vendor’s Applications no later than two weeks prior to the event. <br />[understand that asatemporaryeventcoordinatorjam responsiblefor meetingCaliforniaState standards and <br />the Environmental Health Department policies and procedures. <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: 2 for vendors only <br />Name of sanitary garbage disposal company: West Valley Disposal <br />Method of disposal of liquid waste for food booths: Vendors Haul-away <br />GENERAL EVENT FILE INFORMATION <br />MH Block Party________________________ <br />Date(s) of Event: SAT. 11/01/2025 Time ofEvent: <br />Location: 25 E Main St. Mountain House, CA 95391 <br />Matthew Disko Earnest <br />1868 E. Hazelton Avenue | Stockton, California 95205] T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD16-02 Pagelofll TEMPEVENTAPP <br />07/01/2025 <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />Event Coordinator (Name): Matthew Disko Earnest Telephone:(510) 239-7080 <br />Mailing Address: 955 S. Prosperity St. Mountain House, CA 95391 <br />Number of Food Booths: 209 407-1550 <br />Total Attendance: 5. Soo