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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />2. <br />3. <br />4. <br />\O<->£ frAacfceOX Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />jiL <br />1868 E. Hazelton Avi <br />EHD 16-02 <br />07/01/2025 <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 $179 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Event Coordinator: < <br />SAN JOAQUIN <br />COUNTY <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 /> Yes [3 No <br /> Yes [71 No <br /> Yes O No <br />ue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pagel of 11 TEMP EVENT APR <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: _2T^ <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: Yxxtv' <br />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />If the 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 />event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental HealthJZtepartment policies and procedures. <br />VAaovcco. \x\aVen-YUXQrs Fa.\< <br />Date(s) of Event: (iY''~7'~^U)Time of Event: <br />Location: VACXO y-QC O-_________________________________________ <br />Event Coordinator (Name): J CXj>Jr\O Telephone: (^^TJ) Let 24 <br />Mailing Address: E- YjoSCYTXiYe. t CA Q5331P <br />Number of Food Booths: 3Q________________________________ <br />Approximate attendance at peak time: Total Attendance: jO, CXX) Average Age: