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Environmental H <br />PERMIT/SERVICES <br />1.Name of Event: <br />2. <br />3. <br />4. elepr <br />5. <br />Total Attendant 6. <br />I <br />1.es <br />Yes2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: <br />Event Coordinator (Nam' <br />Mailing Address: . <br />Number of Food Booths^__________________ <br />Approximate attendance at peak timezzQO^ <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 $162 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />(Al l Ilfcyz <br />JUN 1 3 2025 <br />ENVIRONMENTAL health <br />TEMPORARY EVENT APPLICATION PE™mSERVICES <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 />Telephon <br />Average Aqe:rO o <br />'jYes <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 />jjS iv Mil Ife d <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 i "I i \ TEMP EVENT APR <br />06/29/2023 PS L I V I <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: / O » . <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths:^C4aX> <br />GENERAL EVENT FILE INFORMATION j . , • q . fl <br />Date(s) of Event: ^7, Time of Event: <br />Location: 1 <br />xdinator (Nami^: xJ&KJL I <br />idress: <br />SAN JOAQUIN <br />' Li-ra T —COUNTY— <br />Z Greatness grows here. <br />Date: