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} Pqu,ry o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> q' '{ <br /> 304£ Weber Avenue 3`d Floor Stockton, • CA 45202-2708 �� <br /> (209)468-3420• Ear:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> -�-' TEMPORARY EVENT APPLICATION <br /> (To be completed and signed by Event Coordinator,then returned to Environmental Health Department w (J _ <br /> Food vendor's Checklists no later than two weeks prior to event) <br /> GENERAL EVENT FILE INFORMATION ���c �J,S, <br /> 1. Name of Event: pAKCAU-6 F3rziEhY-F-A 651%A7-1th of J%aLl <br /> 2. Date of Event: 3ut_1 4 r Zoo+ Time of Event: -Too A M. Duration of Event: `� 4touES <br /> 3. Type of Event:0 1695 ❑ 1698 "`Please see Notice to All Temporary Event Organizers'}"' <br /> 4. Location: 1101 W. um"g-e- �opfl, l,ont, ct- �52sF2 3-s" <br /> 5. Event Coordinator(Name): CmrLt, MC11Ftt.;1C\s Telephone: (U)) �- 0942- <br /> Mailing Address: P.O. 3c)c 7rn1 LQvt� C_- ( �C 4 _ <br /> 6. Number of Food Booths: Number of Food Handlers: 3 O ❑ Profit ,g Non-Profit <br /> 7. Approximate attendance at peak time:3000 Total Attendance: 30O o Average Age: 3S <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ® Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes [5� No <br /> 3. Are janitorial facilities available: ® Yes ❑ No <br /> 4. Number of toilets provided: 4 7. V <br /> 5. Name of sanitary garbage disposal company: Cgs-Azar. IALWN Wasg_ Number of dumpsters: 2- <br /> 6. Method of disposal of liquid waste for food booths: eti lAat <br /> Wms-reWstTev- 1` snl"4 <br /> APPLICATION <br /> 1. Submit the following to Environmental Health Department two weeks prior to the event: <br /> a) Temporary Event Application <br /> b) Application Review Fee $93.00 hour with a 1 hour minimum <br /> C) Temporary Food Facility food vendors permit application <br /> d) Site Plan <br /> 2. If Festiva[/Event is selected for inspection, the Event Coordinator will be billed for inspection time: <br /> $93.00 per hour, weekdays 8:00 am to 5:00 pm. <br /> After regular business hours, weekday, weekends and holidays, the inspection is charged at <br /> the hourly rate, calculated at one and a half times. <br /> This application is to be completed and signed by the Event Coordinator, then returned to Environmental Health <br /> Department with all food Vendor's Checklists no later than two weeks prior to event. <br /> I understand that as a temporary event organizer, I am responsible for meeting State standards as <br /> described in the Department of Environmental Health policies and procedures, <br /> Event Coordinator: Date: ro <br /> Fart CI-41x.I5 M EVI�L O S <br /> EHD-16-02-002 Page 1 of 9 TEMP EVENT APP <br /> 80/2003 <br />