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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: 6.ct)\ <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />I understand that as a temporary event coordinator, I <br />standards and the <br /> No <br /> No <br /> No <br />LiB f’: <br />^Yes <br />'fhi Yes <br />5^ Yes <br />SAN JOAQUIN <br />■-------COU NTY- <br />Greatness grows here. <br />UTILITIES <br />1. <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page lot 11 TEMP EVENT APP <br />06/19/19 <br />Total Attendance^O^Cj^^ <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 />GENERAL EVENT FILE INFORMATION <br />Name of Event: <5 a) cH-a "rig.Aivk.------------------------------------------- <br />Date(s) of Event: IH 2^1 -CTcn I Time of Event: -k <br />Location: loJvwS^ CA----------------------------------------------- <br />Event Coordinator (Name): Telephone. $2.^ ^$0 -------- <br />Mailing Address: & U uy.jnV' --------------------- <br />Number of Food Booths: <br />Approximate attendance at peak time: Oo <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: AU <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 />• $152 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 $684.00 <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 />am responsible for meeting California State <br />konmental Health Department policies and procedures.