Laserfiche WebLink
TEMPORARY EVENT APPLICATION <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />6.Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />TEMP EVENT APPEHD 16-02 <br />08/01/16 <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 />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 />San Joaquin Count'. <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd >. <br />Name of Event: C t <br />Date(s) of Event: March <br />Location: ^>37^- S <br />Event Coordinator (Name): Maar ic < n < <br />Mailing Address: <br />Number of Food Booths: I <br />Approximate attendance at peak time: 4-00 <br />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 />• 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 />^3 <br />— -...............—------------------- --------------------------- <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health DepartmenTwwQarMfy <br />of the Food Vendor’s Applications no later than two weeks prior to 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 />Event Coordinator: <br />Page 1 of 11 <br />AyiHLIAI OptYj tjPciSC <br />\Time of Event: 11 I PM <br />GA <br />Telephone: <br />Is potable water supplied and available for each food vendor: M Yes No <br />Is electricity supplied and available for each food vendor: E’Yes No <br />Are janitorial facilities available: , [EfYes No <br />Number of toilets provided: l/> (rf/VDOm <br />Name of sanitary garbage disposal company: AnCnV~Number of dumpsters: I "cXO <br />Method of disposal of liquid waste for food booths: < i i - 5 ■- ■ <br />Total Attendance: [ O