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°PqU N SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEP, FMENT <br /> .P 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �\FpRa <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/e D <br /> TEMPORARY EVENT APPLICATIONDD <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health DIment ith 1112019 <br /> of the Food Vendor's Applications no later than two weeks prior to event RONME <br /> PERMIT/ERVI HEATH <br /> GENERAL EVENT FILE INFORMATION CES �r <br /> 1. Name of Event: <br /> 2. Date(s)of Event: 1( 1 2 v ), `Time of Event: <br /> 3. Location: 5 S /� t (t f" <br /> 4. Event Coordinator(Name): V phone: (qo ,-5 d3S <br /> ` <br /> Mailing Address: � A <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time. Total Attendance: Average Age: 02� <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: If Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: E?] es ❑ No <br /> 3. Are janitorial facilities available: 2-^'Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: lr ,ti- Number of dumpsters: <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 Event Application <br /> b) Application Review Fee of$139 <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 selected for inspection, the Event Coordinator will be billed for inspection time: <br /> • $139 per hour(weekdays 8:00 am to 5:00 pm) <br /> • After regular business hours (weekday, weekends and holidays)the inspection is charged at the <br /> hourly rate, calculated at one and one half times($208.50 per hour) <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 aFp responsible for meeting California State <br /> standards and the E vi nmental Hea De rtment polici sand procedures. <br /> v 1zo � <br /> Event Coordinator: w' "" Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />