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2 <br />3. <br />4. <br />5 <br />^5 30 Average Age b I6Total Attendance: <br />2. <br />3. <br />4. <br />5.Number of dumpsters. <br />6 <br />APPLICATION <br />1. <br />2 <br />U 0 6 50^5Date:Event Coordinator. <br />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 $172 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br />□pNb <br />[J No <br />Environmental Health Department <br />n-2’ <br />TEMPORARY EVENT APPLICATION <br />Io be completed and signed by Event Coordmalot, 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 />SAN JOAQUIN <br />( OUN1V <br />LdYes <br /> Yes <br />{□Ves <br />■I I /1H|ZO OP­ <br />GENERAL EVENT FILE INFORMATION <br />1 <br />UTILITIES <br />1 <br />1868 E Hazelton Avenue | Stockton, California 95205 1 T 209 468-3420] F 209 464-0138 | www sjgov org/ehd <br />EHD 16-02 Paoe 1 of 11 TEMP EVENT APP <br />Name of Event <br />Date(s) of Event <br />Location CORPUS < E. <br />Event Coordinator (Name) <br />Mailing Address L • p-] U Nl L □- V <br />Number of Food Booths jL <br />Approximate attendance at peak time: <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $172 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 $774.00 <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor. <br />Are janitorial facilities available. <br />Number of toilets provided C.O^Q£> [OI <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths. <br />HQSAT&AM /fcYg <br />I \ - 2 V '2-jSTime of Event P <br />Telephone. ( 4 1$^ 6 / H S