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Environmental Health Department <br />i <br />2 <br />3 <br />Telephone (90^ 086-7502Mark Landon4 <br />5 <br />18006Approximate attendance at peak time: <br />UTILITIES <br />1. <br />2 <br />3 <br />4 <br />TBA I5Number of dumpsters <br />6 <br />APPLICATION <br />1 <br />2 <br />(v 12/26Event Coordinator Date <br />£ <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 />53 Yes <br /> Yes <br />0 Yes <br /> No <br /> No <br /> No <br />/Vf 2^0 2,^02. <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 />Total Attendant^. <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: Paranormal Cirque <br />Date(s) of Event July 3 - 6 Time of Event: Varies 5:30 - 11:30 pin <br />Location: West Valley Mall, 3200 Nat»lee Rd. Tracy_____________________________ <br />Average Age ' ^0 <br />Event Coordinator (Name) <br />Mailing Address 2903 9th St._Wcst. Bradenton. FL 34205 <br />Number of Food Booths (Two <br />300 <br />SANJOAOUIN <br />------COUNTY- <br />, Greatness ^ron- here <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page I of 11 TEMP EVENT APP <br />07/01/2025 <br />Is potable waler 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 4 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: Tanks, dumped, as needed <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 charge J 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 retumvd 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 eyent coordinator. I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures