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Environmental Health Department <br />JOpn} <br /> <br />IM <br />es <br /> Number of dumpsters: <br />1. <br />2. <br />Date: <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br /> No <br /> No <br /> NoJxlYes <br />SANJOAOUIN <br />-----COUNTY------ <br />Greatness grows here. <br />Telephone: <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: . <br />Date(s) of Event: <br />Location: <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths:-----------------------------— <br />Approximate attendance at peak time: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Is potable water supplied and available for each food vendor. <br />Is electricity supplied and available for each food vendor. <br />Are janitorial facilities available: <br />Number of toilets provided:--------- <br />Name of sanitary garbage disposal company:------ <br />Method of disposal of liquid waste for food booths. <br />APPLICATION <br />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 />Total Attendance: 0(9^Average Age: <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Heafth Department With all <br />To be completed anosig App|icatjons n0 |aler than tw0 weeks poor to event <br />Submit the <br />a) <br />b) <br />c) <br />d) <br />e) <br />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) at a <br />. After regular business hours (weekday, weekends and holidays) the inspection is charged at <br />minimum three-hour overtime rate of $702.00 Coordinator then returned to the <br /> ^nvironm^nta^Health^Department^with a^Foo^Vendor^s Aprons <br />f^derstand 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: ------------------- <br />« t 468-3420 I F 209 464-0138 | www.sjgov.org/ehd <br />1868 E. Hazelton Avenue | Stockton, California 95205^ T^ 209 d | TEmp event app <br />EHD 16-02 i . Zi <br />06'19'19 <br />Time of Event: <br />V* PB:____