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Environmental Health Department <br />TEMPORARY EVENT APPLICATION <br />of the Food Vendor's Applications no later than two weeks prior to event <br />2. <br />3. <br />4.831-8741 <br />5. <br />350 . 7506.30Total Attendai <br />2. <br />3. <br />4. <br />25.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />04-17-2025Date: <br />Name of Event: <br />Date(s) of Event: <br /> Yes <br /> Yes <br />0 Yes <br />0 No <br />0 No <br /> No <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) Ternporary Event Site Plan <br />e) Food Vendor List <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 />07/01/2024 <br />SAN JOAQUIN <br />-—COUNTY— <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <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 Environmental Health Department policies and procedures. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />WEST VALLEY DISPOSAL <br />CHEMICAL TOILET ON SITE <br />UTILITIES <br />1. <br />MOUNTAIN HOUSE CERTIFIED FARMERS* MARKET <br />SUNDAYS-YEAR ROUND Timft Qf 9AM-1PM <br />Location: 251 E- MAIN STREET, MOUNTAIN HOUSE, CA 95391 <br />Event Coordinator (Name):_BILL HARLOW - . Telephone- ( 40^_ <br />Mailing Address: ROB 9898, SOUTH LAKE, TAHOE, CA 96158 <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />Event Coordinator: -t r Eh-yv— <br />j__Average Age: <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: ONE (1) <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: