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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />time: 1500 306.Total Attendancl <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: 12Yard5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Oct. 18th, 2024Event 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 $172 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />S’Yes <br />S^Yes <br />SYes <br />□ No <br />□ No <br />□ No <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pagel of 11 TEMP EVENT APPtown <br />Average Age^L 2500 <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $172 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 $774.00 <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 Environmen^Kealth Department policies and procedures. <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: Day of the Dead Block Party in Mountain House <br />Date(s) of Event: Saturday, November 1st, 2024 Time of Event: 1700-2200 PDT <br />Location: Mountain House Central Community Park - 25 E Main Street, Mountain House, CA <br />Event Coordinator (Name): Matthew 'Disko' Earnest Telephone: (209)407-1550 <br />Mailing Address: 212 WJ^osperidad Way, Mountain House, CA 95391 <br />Number of Food Booths: I'' 8 <br />Approximate attendance at>ea1< tir <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: <br />Name of sanitary garbage disposal company: West Valley Disposal <br />Method of disposal of liquid waste for food booths: Wet Dumpster