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Environmental Health Department <br />Name of Event: <br />4. <br />5. <br />(fOC) Total Attendance: 12-006. <br />Yes <br />Yes <br />6. <br />APPLICATION <br />1. <br />2. <br />2. <br />3. <br />2. <br />3. <br />4. <br />5. <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 /> No <br /> No Yes <br />Ik <br />Telephone: ( <br />(ft <br />SANJOAQUIN <br />-COUNTY­ <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 />______Time of Event:p/vi <br />S> Lei' GI¥ <br />)>T-&1c-gno <br />PeUa ty <br />Number of dumpsters: up cft'V <br />X Event Coordinator: _____________ <br />/ / /x <br />1868 E. Hazelton Averse | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />O7'<,,'2°24 x PR 2-5 COHujj <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 />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />Average Age: O 7 <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 Fdod Vendor’s Applications no later than two weeks prior to the <br />event. / / <br />I understand that as a tempgrary event coordinator, I am responsible for meeting California State <br />standards and the Environrpepial Hegfth Department policies and procedures. <br />skk <br />LtAx - <br />Date(s) of Event: s <br />Location: <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: ® <br />Approximate attendance at peak time: