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ItEnvironmental Health <br />A'R 2 0 2026 <br />ENVIRONMENT HEALTH <br />6:30 - 11:30 AMTime of Event:.2. <br />Telephone: (209) 570-3108 <br />5. <br />Average Age: 35Total Attendance: 2,8006. <br />2. <br />3. <br />4. <br />Number of dumpsters: 45. <br />6. <br />APPLICATION <br />1. <br />2. <br />9-/6-^Date:Event Coordinator: <br />3. <br />4. <br /> No <br /> No <br /> No <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: 10 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />a) <br />b) <br />c) <br />d) <br />e) <br />O'Yes <br />□"Yes <br />Q^Yes <br />SANJOAOUIN <br />-COUNTY----- <br />Greatness grows here. <br />Name of Event: 4 of July Pancake Breakfast <br />Date(s) of Event: July 4, 2026 ___ <br />Location: 1101 W. Turner Road, Lodi, California <br />Event Coordinator (Name): Tony Fachner <br />Mailing Address: P.O. Box 761, Lodi, California 95241 <br />Number of Food Booths: One <br />Approximate attendance at peak time: 800 <br />Waste Management_____ <br />Taken to Dump Station <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov^g/ehd^ <br />EHD 16-02 Pagel of 11 <br />07/01/2025 0 <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 />-J/./POP-' <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $179 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />If event is selected for inspection, the Event Coordinator will be billed for inspection time. <br />• $179 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 $805.50 <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 />QVQntI understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures.