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IW) <br />Environmental Health Department <br />Average Age: 1^-50Total Attendance: 36T <br />'1. <br />2. <br />3 - /5 - ^34Date. <br />5. <br />6. <br />39b 2 ^33- <br />IV Cfi- 7531^ <br />[^Yes No <br />•^Yes No <br />jj/fYes No <br />SAN.JOAQUIN <br />------COUNTY------ <br />TEMPORARY EVENT APPLICATION <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health DepA^fe^ with all <br />of the Food Vendor’s Applications no later than two weeks prior to evenjt^^ J ^>7 <br />1868 E. Hazelton Avenue | Stockton, California 95205 1 209 468-3420 | F 209 464-0138 | vmw.sjcehd.com <br />rSyC • v* • • <br />EHD 16-02 <br />Name of Event: K)CtLtt&mlQU <br />Date(s) of Event: ftPR'll- 3, 0 5 - 2 Time of Event: <br />Location: /I335 ^2), ZZ>£>/ Cfl 952U0_________ <br />Event Coordinator (Name). MATT-lZM/ ’S^Telephone. <br />Mailing Address: 3^9. "Thui/^iJ&k/b- di?, xtnck <br />Number of Food Booths: 2,5 -___ <br />Approximate attendance at peak time: ^50 <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 (WTl/ l/^/W-A^umber of dumpsters: <br />Method of disposal of liquid waste for food booths "T*/?/ <br />APPLICATION <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $i52-per hour (weekdays 8:00 am to 5:00 pm) <br />. Afterfegular business hours (weekday, weekends and holidays) the inspection >s charged at the <br /> ““s”’ <br />Event Coordinator