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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />C) Total Attendance: 6.Approximate attendance at peak time:Average Age: <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />/i-'/I VW,Event Coordinator: \Date: <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 />1868 E. Hazelton Avenge | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <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 />SANJOAOUIN <br />- COUNTY <br />Greotness qrOWS here <br />CenieC________ <br />Telephone: Off?) S ( <br />i "iVlz?j C/{ ^63 34- <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 />event. <br />I 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 />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. Yes 0 No <br /> Yes [2 No <br /> Yes No <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:Z)~ <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: F' 7 * <br />- Number of dumpsters: QY <br />Fe-OicX* <br />Name of Event: <br />Date(s) of Event: / —‘'V T- ~ Time of Event: { In <TT t <br />Location: "FZYirVT/0/! (3 ho/)Z)/L,___ <br />Event Coordinator (Name): <br />Mailing Address: / C> C't /t A/ L? <br />Number of Food Booths: .. y_______________________