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°p4u� SAN JOAQUIN COUNTY ' <br /> •.P� <br /> a' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Wets:www.sigov.org/ehd <br /> a <br /> TEMPORARY EVEN` ' APPLI�ATION <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 /> tol1. Name of Event; 1�- - r^'�rar � l 1 '41- I0'1t <br /> 2. Date(s) of Event: l� ` 2 ZL� l,m of Event: P_ � <br /> l <br /> 3. Location: <br /> 4. Event Coordinator(Name): Am Telephone: (ZeA) Sty caC�4S' <br /> Mailing Address: 3 t'n -- lOD &e- <br /> 5. Number of Food Booths: Cam ' <br /> 6. Approximate attendance at peak time: SC7 Total Attendance: D Average Age: 30 <br /> UTILITIES <br /> t <br /> E <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 (�No <br /> 3. Are janitorial facilities available: , Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: � '✓t umber of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: y' <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$130 <br /> c) Temporary Food Vendors Applications for each booth i <br /> 3 <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 /> $130 per hour(weekdays 8:00 am to 6:00 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 ($195.00 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 a temporary event coordinator, I am responsible for meeting California State <br /> standards and the En irpnme al e th Department policies and procedures. <br /> Event Coordinator: } Date: ���Z-6 <br /> EHD 16-02 Pa0e 1 of 11 TEMP EVENT APP <br /> 7/14115 <br />