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SAN JOAQUIN <br />----COUNTY -- <br />Greatness grows <br />Environmental Health Department <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 />, <2 <br />1. Name of Event: '',!! )ht; 1 , LA; <br />Date(s) of Event: 4----ir")(\'S,•;._APLi Time of Event: 5 46 is Peici <br />Location: '3 c.\-1 1, -1..)1 iNibi..c) P\ It:- a,- CA. Cr' r),0 <br />Event Coordinator (Name): M PCK; 11/44 1...) Telephone: (.12-01) <br />Mailing Address: Address: i) , LF • `54,-),--kal--- • (IA So/- <br />of Food Booths: 11 <br />Approximate attendance at peak time: '5(1) Total Attendance: Average Age::)--f <br />UTILITIES <br />Is potable water supplied and available for each food vendor: 7] Yes 0 No <br />Is electricity supplied and available for each food vendor: La Yes El No <br />Are janitorial facilities available: E Yes 0 No <br />Number of toilets provided: <br />Name of sanitary garbage disposal company:i2-..*...0(...fr,z)L <br /> <br />Number of dumpsters: <br /> <br />Method of disposal of liquid waste for food booths: <br /> <br />APPLICATION <br />1. Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $156 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />$156 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 $702.00 <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 />Event Coordinator: Date: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd EHD 16-02 Page 1 of 11 TEMP EVENT APP 06/19/19