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Environmental Health Department <br />LQ <br />Total Attendance: <br />APPLICATION <br />1. <br />2. <br />12-/4/^Date:Event Coordinator: _l <br />5. <br />6. <br />E2 Yes <br />Q Yes <br />@ Yes <br /> No <br /> No <br /> No <br />1. <br />2. <br />3. <br />4. <br />Name of Event: <br />Date(s) of Event: J | <br />Location: : <br />Event Coordinator (Name): cX> <br />Mailing Address: 1 <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />Telephone: ftlC) %ZJ<d <br />'0. <br />2018 <br />^e^ri <br />SAN JOAQUIN <br />— C O U N T Y <br />n <br />Number of dumpsters:^: <br />f3 ) <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Depar^ot wftff <br />of the Food Vendor’s Applications no later than two weeks prior to event c ' Q j <br />GENERAL EVENT FILE INFORMATION r, <br />U.\av-________________ <br />pGrx Ip .2^1‘T' Time of Event: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />EHD 16-02 Pagel of 11 TEMP EVENT APR <br />07/3/17 <br />Average Age: <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 the <br />hourly rate, calculated at one and one half times ($228 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 />QVQnt. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the^nvironmental Health Department policies and procedures. <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:/ 73_____ <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: