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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT i <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.orglehd <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 /> GENERAL EVENT FILE INFORMATION ' <br /> �rural��s-" t S <br /> 1. Name of Event: J <br /> 2. Date(s)of Event: ��12 IA-,'t!. ,5�2� Time of Event:�Serr\ <br /> 3. Location: c-,� aCop,,,.ter <br /> 4. Event Coordinator(Name): �-0� `^^LJ Telephone: (121_M Sal- 23 C) L i <br /> Mailing Address: 23b srli1, -Df CA- IS-130 T <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: S Total Attendance: Average Age: �S <br /> UTILITIES 1061l'�� .!'/,Z7- <br /> {ZA �Za <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes -kNo <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes ;�tNo <br /> 3. Are janitorial facilities available: ,KYes ❑No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company:Qe-5y \Ji4 4 Y► Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: kk", <br /> APPLICATION <br /> 1. 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$139 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List <br /> 2. If the event is selected for inspection,the Event Coordinator will be billed for inspection time: <br /> $139 per hour(weekdays 8:00 am to 5:00 pm) <br /> • After regular business hours(weekday,weekends and holidays)the inspection is charged at the <br /> hourly rate, calculated at one and one half times ($208.50 per hour) <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 a5nntal <br /> orary event coordinator, I am responsible for meeting California State <br /> standards and the En r Health Department policies and procedures. <br /> *3/Event Coordinato Date: <br /> EHD 16-02 Page 3 of 11 TEMP EVENT APP <br /> 08101/16 <br />