Laserfiche WebLink
rANi 44 <br /> ' SANPJOAQUIN 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 /> 1. Name of Event: <br /> 2. Date(s)of Event: ,,Time of Event. <br /> 3 Location: IIJ 3S- P��L,.t5(,,�v dPG 1loo1_ C'fi 1750nZ6) - <br /> 4. Event Coordinator (Name): ()C) OL -Telephone: (21-9 �} <br /> Mailing Address; <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor, Vi Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: (_/Yes ❑ No <br /> 3. Are janitorial facilities available: i Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: a_Je Number of dumpsters:r �t0 <br /> 6 Method of disposal of liquid waste for food booths <br /> APPLICATION <br /> 1 Submit the following to the Environmental Health Department two weeks prior to the event: <br /> a) Temporary Evert Application <br /> b) Application Review Fee of$162 <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 setected for inspection, the Event Coordinator will be billed for inspection time: <br /> $162 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$729.00 then returned to the <br /> This application is to be completed and signed by the Event Coordinator, <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 95 05 T 209 468-3420 1 F 209 464-0138 www.sigov.�g/ehdTEMP VENT eP <br /> Fhr1 <br />