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°pa�.�+�, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> `?R;F R?� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www,sjgov.org/ehd <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 /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: lk\i t z ye le F%t <br /> 2. Date(s) of Event: kOVXy \y WIta Time of Event: 10� <br /> 3. Location: Y%acd 6'' uce M,-,wUh L✓1 <br /> 4. Event Coordinator(Name): _Telephone: (70'%) y(0g' <br /> Mailing Address. 1(obl f;.. I A e Slpdonn cA Anos <br /> 5. Number of Food Booths: _ <br /> 6. Approximate attendance at peak time: 200 Total Attendance: Z.� Average Age: 1$-}' <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes X No <br /> 2. Is electricity supplied and available for each food vendor,- ❑ Yes KNo <br /> 3. Are janitorial facilities available: ❑ Yes $C No <br /> 4. Number of toilets provided: WME <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: N p4 <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$130 <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 /> • $130 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 ($195.00 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 Foot! 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 En ironmental Health Department policies and procedures. <br /> Event Coordinator: Date: 6 <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 7114115 <br />