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S A N J O A Q U I N Environmental Health Department <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 /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event:HOPS &GOBLINS BEERFEST <br /> 2. Date(s)of Event:OCTOBER 28, 2023 Time of Event:6:00PM-10:00PM <br /> 3. Location:413 E. LOCKEFORD ST. , LODI, CA. 95240 <br /> 4. Event Coordinator(Name)-.MARK ARMSTRONG Telephone: (209) 369-2771 <br /> Mailing Address:PO BOX 848, LODI, CA. 95241 <br /> 5. Number of Food Booths:4 <br /> 6. Approximate attendance at peak time:1300 Total Attendance: 1 500 Average Age: 4 0 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: X❑Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ❑X Yes ❑ No <br /> 3. Are janitorial facilities available: ®Yes ❑ No <br /> 4. Number of toilets provided:25 <br /> 5. Name of sanitary garbage disposal company:CAL WASTE Number of dumpsters:4 <br /> 6. Method of disposal of liquid waste for food booths:CITY SEWER <br /> APPLICATION <br /> 1. 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 /> 2. 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 /> Event Coordinator. Date: SEPTEMBER 29 2023 <br /> 1868 E Hazelton Avenue I Stockton. California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16.02 Page 1 of 11 TEMP EVENT APP <br /> 06/29/2023 <br />