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i <br /> OAN JUAUUIN VUUN ' — <br /> <� ENVIRONMENTAL HEALTH ❑& ,,,RTMENT C <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4t�FapN�" Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www slgov.orq/ehd <br /> ENV1R0Ni 4ENTN_HEALTt l <br /> TEMPORARY EVENT APPLICATION PERMIrhFRVlCES <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 /> 1- Name of Event: LOU(LIT E4 0� JU caVX-- S¢LAyr-4% <br /> 2. Date(s) of Event: J U4 J 41, S G 4(a Time of Event: ?V 00 A.A. <br /> 3. Location: 1101 y 1. -TU9-u4az- *-oxxp Lan t- --- -- <br /> 4. Event Coordinator(Name): SA'bog C�sZ-L Telephone: (20") '703- 2-755 <br /> Mailing Address: Q U, 6o)c ~?Cvl LAnt GA 967,4i <br /> 5. Number of Food Booths: i <br /> 6. Approximate attendance at peak time: 4 Total Attendance: 300o Average Age: 2S <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: 54 Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes ❑ No Nis[ WE£09,D <br /> 3. Are janitorial facilities available. ❑ Yes ❑ No <br /> 4. Number of toilets provided: 10 <br /> 5. Name of sanitary garbage disposal company: Cej*raA gakl Writ'¢ Number of dumpsters: 2 <br /> 6. Method of disposal of liquid waste for food booths: K%, U Q t La o1 <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 <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 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($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 th a tem ora eve co rdinator, I am responsible for meeting California State <br /> standards an the Enviro ntai H at ep ment policies and procedures. <br /> Event Coordin Date: i ` T <br />