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Docusign Ertvelope ID: 3FCBD705-CB30-43D4-AD6B-B0E07677700C <br />Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />7/25/2024 <br />Date: Event Coordinator: <br /> Yes <br /> Yes <br /> Yes <br /> No <br />H No <br />S No <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 APP <br />06/29/2023 <br />a) <br />b) <br />C) <br />d) <br />e) <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 />,-----DocuSigncd by: <br />-----D31F2E7BB9CC482. <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />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 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 />Number of dumpsters: J. <br />Approximate attendance at peak time: ^QQ Average Age: 40 <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: National Night Out <br />Date(s) of Event: August 6, 2024 Time of Event: 5.00-8.00pm <br />Location- Central Community Park, Mountain House <br />Event Coordinator (Name): Laura Johnston Telephone: ( <br />Mailing Address- 251 E Main Street, Mountain House, CA 95391 <br />Number of Food Booths: 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: <br />Name of sanitary garbage disposal company: West Valley Disposable <br />Method of disposal of liquid waste for food booths: vend0'sw"1131(6Wlth'hem <br />Total Attendance: 500 <br />) 209-831-5668 <br />Si