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^>(2. 0 5 Ml 'OMCj <br />1. <br />2. <br />3. <br />4. <br />5. <br />1,5001,000 Total Attendance:6.Approximate attendance at peak time: <br />1. <br />2. <br />3. <br />4. <br />1Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />6/16/26Laura Johnston Date:Event Coordinator: <br />s <br />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />□ Yes <br />□ Yes <br />□ Yes <br />[S No <br />□ No <br />□ No <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />06/29/2023 <br />Environmental Health Department <br />FA OO23SSH <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 />Greatness grows here. <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $162 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 $729.00 <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 event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />UTILITIES <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: <br />Name of sanitary garbage disposal company: West Valley Disposable <br />Method of disposal of liquid waste for food booths: vendll'sw'" lak0,,v"h lhcm <br />GENERAL EVENT FILE INFORMATION <br />Name of Event' Independence Day Celebration <br />Date(s) of Event: July 2026 Time of Event: 9am-1 pm <br />Location: Central Community Park, Mountain House <br />Event Coordinator (Name): Laura Johnston Telephone: ( <br />Mailing Address' 251 E Main Street, Mountain House, CA 95391 <br />Number of Food Booths: <br />} 209-831-5668 <br />Average Age: 40