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Environmental Health Department <br />2. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: 10/15/2023Event Coordinator: HARRY DHILLON <br />l <br />_______ <br />otal Attendance <br />3. <br />4. <br />E Yes <br />KI Yes <br />® Yes <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 />Average Ag^^ y1 <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 />Name of Event: HISPANIC HERITAGE CELEBRATION <br />Date(s) of Event: 11/04/2023.Time of Event: 12 PM-4 PM <br />Location: MOUNTAIN HOUSE CENTRAL PARK 25 MAIN ST. MOUNTAIN HOUSE CA 95391 <br />Event Coordinator (Name): HARRY DHILLON^Telephone: (209) 607-4222 <br />Mailing Address: 52 W^FAUNA CT MOUNTAIN HOUSE CA 95391 <br />Number of Food Booth^: <br />Approximate attendance at peak time: 200 <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <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: 3 <br />Name of sanitary garbage disposal company: WEST VALLEY DISPOSAL Number of dumpsters: 2. <br />Method of disposal of liquid waste for food booths: VENDORS RESPOSIBILITY <br />a) <br />b) <br />c) <br />d) <br />e) <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 £nd procedures. <br />----- <br />1868 E. Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Paae 1 of 11 TEMP EVENT APP <br />06/29/2023 <br />SANJOAQUIN <br />;-----COUNTY------ <br />Greatness grows here. <br />400