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Environmental Health Department <br />6 <br />St. Bernards Parish Fall FestibvalName of Event: <br />2.Time of Event: 10:00 arn to 8:00 Pm <br />3. <br />4.Telephone: (209)607-7308 <br />5.7 <br />1 Average <br />7 nVCIdyc _/ <br />15003506.Approximate attendance at peak time:Total Attendance: <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />LEvent Coordinato Date: 4- <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 $172 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />linator, I am responsible for meeting California State <br />lepartmhnt policies and procedures. <br />□ No <br />□ No <br />□ No <br />p A ooos\o 5^ <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 />SAN JOAQUIN <br />------COUNTY—- <br />□ Yes <br />□ Yes <br />0 Yes <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 1 of 11 TEMP EVENT APP <br />07/01/2024 <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 />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 ev^nt co< <br />standards and the Environmental Heal' <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />Date(s) of Event: <br />Location- w‘ Eaton Ave- Tracy ca 95376 <br />September 14th & 15th, 2024 <br />___Number of dumpsters: 3 <br />Oil will be disposed of at drop location <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: Tracy Disposal <br />Method of disposal of liquid waste for food booths: Drain in Kitchen, <br />Event Coordinator (Name): Marie Mifsud <br />Mailing Address: 163 w- Eaton Ave- Tracy, ca 95376 <br />Number of Food Booths: