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Environmental Health Department <br />11:00 am - 7:00 pm <br />Telephone: (209 329-5047 <br />Total Attendance: 700 Average Age: 40 YO <br />Number of dumpsters:one four yard <br />APPLICATION <br />1.event: <br />2. <br />then returned to the <br />responsible for meeting California State <br />Event Coordinator: Date: September 18, 2024 <br />5. <br />6. <br />Temporary Event Application <br />Application Review Fee of $172 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />H Yes <br /> Yes <br /> Yes <br /> No <br />0No <br />KI No <br />SAN.JOA0UIN <br />------COUNTY------ <br />EHD Hazelton Avenue 1 Stockton-California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjgov org/ehd <br />07/W2W4 Pa9S 1 11 TEMP EVENT APP <br />a temporary event coordinator, I am i - ' <br />alth Department policies and procedures. <br />This _ _ _____f ________ <br />Environmental Health Department with all Food^Vendor’s Applications no later than two weeks prior to the <br />Submit the following to the Environmental Health Department two weeks prior to the <br />a) <br />b) <br />c) <br />d) <br />e) <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: Six Portable w/wash stations <br />Name of sanitary garbage disposal company: Waste Management <br />Method of disposal of liquid waste for food booths: Carried Out <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <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 />Name of Event: Fusion Music Festival <br />Date(s) of Event: September 29, 2024 Time of Event: <br />Location: 1101 W Turner Rnad, I ndit QA 95249 <br />Event Coordinator (Name): Chet Somera <br />Mailing Address: P.O.Box 2326, Lodi, CA 95242 <br />Number of Food Booths: Seven <br />Approximate attendance at peak time: 500 <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 />application is to be completed and signed by the Event Coordinator, <br />event. <br />I understand that as <br />standards and the Environmental