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S A N J Q A Q U 1 N Environmental Health Department <br /> 0 U 1,111 F Y .. _ /1 <br /> TEMPORARY EVENT APPLICATf ,, <br /> �a1� <br /> 'I -P'VIt7� <br /> �t` 1- <br /> To be completed and signed by Event Coordinator, then returned to the Environmental He �Y1-Ff1 �tlrth all <br /> of the Food Vendor's Applications no later than two weeks prior to event CQ <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: 4th Annual Chicano Community Program Radio Reunion&Car Show <br /> 2. Date(s) of Event: 9/9/2018 Time of Event: 11am-6prn <br /> 3. Location: Oak Grove Regional Park, Eight Mile Rd, Stockton <br /> 4. Event Coordinator(Name): Betty Ramirez Telephone: (209) 470-9585 <br /> Mailing Address: 231 Bedford Rd,Stockton,CA 95204 <br /> 5. Number of Food Booths: 1 <br /> 6. Approximate attendance at peak time: 100 Total Attendance: 200 Average Age: 21 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: El Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: 0 Yes ❑ No <br /> 3. Are janitorial facilities available: 0 Yes ❑ No <br /> 4. Number of toilets provided: 2 <br /> 5. Name of sanitary garbage disposal company: Waste Management Number of dumpsters: 1 <br /> 6. Method of disposal of liquid waste for food booths: sewer <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 /> I understand that as a temporary event coordinator, I am responsible for meeting California State <br /> standards and the Envir ental Health epartment policies and procedures. <br /> Event Coordinator: Date: 8/30/2018 <br /> 1868 E. Hazelton Avenue ( 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 />