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S A N J OA Q U I N Environmental Health Department <br /> ( )W Il Y <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 BREW FEST <br /> 2. Date(s)of Event: OCTOBER 30, 2021 Time of Event: 1 PM-5PM <br /> 3. Location: 413 E. LOCKEFORD ST. LODI, CA. 95240 <br /> 4. Event Coordinator(Name): MARK ARMSTRONG Telephone: ( 209_369-9771 <br /> Mailing Address: P.O. BOX 848, LODI, CA. 95241 <br /> 5. Number of Food Booths: 3 <br /> 6. Approximate attendance at peak time: 1500 Total Attendance: 2000 Average Age: 35 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ® Yes ❑ No <br /> 2_ Is electricity supplied and available for each food vendor: ® Yes ❑ No <br /> 3. Are janitorial facilities available: ® Yes ❑ No <br /> 4. Number of toilets provided: 4 PERMANENT RR <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$152 <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 /> • $152 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$684,00 <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: OCTOBER 7, 2021 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br /> DID 16-02 Page 1 of 11 TEMP EVENT APP <br /> 06I19/11) <br />