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4 <br />1^0 o(\oC} Total Attendance Average Age <br />4 <br />APPLICATION <br />1 <br />2 <br />meeting California State <br />I vent Coordinator <br />5 <br />6 <br />1 <br />2 <br />3 <br />®Yes <br />[XI Yes <br />CX Yes <br /> No <br /> No <br /> No <br />5 <br />6 <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 S179 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />then returned to the <br />j weeks prior to the <br />Environmental Health Department <br />t>AcI <br />X Q 1^5______Time of Event p/M <br />(6sa 002^ <br />, rAy k - ci | <br />SAN JOAQUIN <br />- COUNTS <br />Grt'nfncss UH'iv!, hri* <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 />^4 u/d£\ <br />UTILITIES <br />1 <br />2 <br />3 <br />r\A fi-bs va. •< <br />Name of Event _ <br />Date(s) of Event <br />Location Q <br />Event Coordinator (Name) <br />Mailing Address <br />Number of Food Booths <br />Approximate attendance at peak time <br />/’■?' r T I <br />i’ <br />jU <br />GENERAL EVENT FILE INFORMATION <br />J ro 0 1A <br />IT- <br />A j1__ <br />Tf C G~ <br />3 <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 TKx/j Te:< <br />If the event is selected for inspection the Event Coordinator will be billed for inspection time <br />• S179 per hour (weekdays 8 00 am to 5 00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charqed at a <br />minimum three-hour overtime rate of $805 50 y <br />Th/s 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 <br />i understand that as a temporary event coordinator, I am responsible for <br />standards and the Environmental Health Department policies and procedures <br />Hazelton Avenue | Stockton, Culjfen.a 95205 i T 209.468-3420 | F 209 454-0138 | WWW siqov oroMhw <br />PWOH, tempe^ntapp <br />Number of dumpsters. <br />Date <br />ITV <br />-----7-Time of Event. <br />FAQ j i <br />j__Telephone <br />,v\c v j>aAt V.