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ppUlM SAN JOAQUIN COUNTY <br /> N ENVIRONMENTAL HEALTH DEPARTMENT ° <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C9�f FOR�`P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd �• ~ <br /> Ewvll� EP 2 0 2016 <br /> s�, „ ENT <br /> TEMPORARY EVENT APPUCATION �Fltn�IrjsFRVs ESTH <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with al <br /> of the Food Vendor's Applications no later than two weeks prior to event <br /> GENERAL EVENT FILE inlrORMA T IOIN' <br /> 1. Name of Event: C- ( I'Vvf l 0xv�z <br /> 2. Date(s) of Event: � ;Roffe Time of Event: I(/li1iY1 �o'.3Z� <br /> 3. Location: �►i/T1L C Q <br /> �- <br /> 4. Event Coordinator(Name):� -r'�•� /l'1'Ll12Z� Telephone: � 535 _ <br /> Mailing Address: 1; � SkkAn r <br /> 5. Number of Food Booths: — rAsok Elcares L�&SV c AOW 2S�t.rc <br /> 6. Approximate attendance at peak time: Total Attendance: ?11Z Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: RYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: K] Yes ❑ No <br /> 3. Are janitorial facilities available: A Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: QzV(-4VA�p&-Pt>JL Number of dumpsters: 1 -2- <br /> 6. Method of disposal of liquid waste for food booths: 11 LX42 / 6vwked IV-1,4 1 <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 /> o 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 am responsible for meeting California State <br /> standards;and the Environ ental ment policies and procedures. <br /> Event Coorator: Date: <br /> EHD 16-02 Pa of 11 TEMP EVENT APP <br /> 08/01/16 <br />