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SAN J OAQU I N Environmental Healt <br /> —COUNTY— T<L <br /> SEP 2 2 2017 <br /> ENVIRONMENTAL HEALTH <br /> TEMPORARY EVENT APPLICATION PERMITISERVICES <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 /> 1. Name of Event: (1_H 1 LT)R _N'S CARNIV"a L k- SI LC N3- UO,-r 1 nN <br /> 2. Date(s)of Event: 1[}ZQ ca I Q ) Time of Event: I Q m <br /> 3. Location: _ 1.1 . n f-1 K ST — LOD r Cf� `a 5 Q y C <br /> 4. Event Coordinator(Name): N i AL i Vil C- -2- Telephone: (ate 36 R - 5 i 1 l <br /> Mailing Address: 'Q nn kx" _ na X ST. LO 171, Q-A 9 5a y a <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: =Qr, Total Attendance: Q(-jC) Average Age: QC <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: 'S Yes ❑ No <br /> 3. Are janitorial facilities available: ® Yes ❑ No <br /> 4. Number of toilets provided: q <br /> 5. Name of sanitary garbage disposal company:QPET E RYlf)N0GCt11ENS Number of dumpsters: L <br /> 6. Method of disposal of liquid waste for food booths: T n- N%-T oRA- L S►N1, <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$152 <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 /> • $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 /> event. <br /> understand that as a temporary event coordinator, I am responsible for meeting California State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: NC&L . )Sig-pa Date: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3/17 <br />