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p4U�N' SAN a1OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AU D <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �,, ,, G 18 Z <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/e R2 411 <br /> PERMS RA/ [Tjil <br /> S <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 1. NameofEvent: , A'awl <br /> 2. Date(s) of Event: Time of Event: n��a L��i 3 Di'Yl <br /> 3. Location: �� .161A �(�r� �GIA 12� VC1 Pi\16r Kd, Ri'OL!) <br /> 4. Event Coordinator(Name): LV pv-) Telephone: (Z�fb " -7519 <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance` Average Age: p <br /> UTILITIES 0 <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes E No Q\eJ <br /> 3. Are janitorial facilities available: ❑ Yes ❑ No 2 <br /> 4. Number of toilets provided: i <br /> 5. Name of sanitary garbage disposal company: G Number-of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: uS V l�i�t dC'f Sl <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 d) Temporary Event Site Plan C c e 1\\1 <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 /> • 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 t ironmental lHealth Department policies and procedures <br /> Event Coordinator: �r lA4— Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />