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SAN JOAQUIN Environmental Health Department <br /> TEMPORARY EVENT APPLICATION <br /> To be completed and signed by E=vent 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 NFORMATION <br /> 1. Name of Event: W %, I 1q7cW (d <br /> Kv2. Date(s)of Event: i ] I k � i�c,('� l3 Time of Event: 1T 'r9 k7 m <br /> 3. Location: �: . I,I;�L �� tt YC j S ��Lt l <br /> 4. Event Coordinator(Name): 1V� �(' ��'�L Telephone: <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: l 1 Total Attendance: ffi <br /> ) Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [A Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: [+ Yes ❑ No <br /> 3. Are janitorial facilities available: E Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: C n �W���� �- _ Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: d <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$156 <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 /> • $156 per hour(weekdays 8:00 am to 5:00 pm) <br /> • After regular business hours(weekday,weekends and holidays) the inspection is charged at a <br /> minimum three-hour overtime rate of$702.00 <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 /> 1 <br /> Event Coordinator: Tv 6' Date: <br /> 1868 F Hazelton Avenue I Stockton, Ci lifornia 952051 T 209 468-34201 f:109 464 0136 � www slgo v wglohd <br /> El f)16-02 Page 1 of 11 TEMP EVENT APP <br /> 06!19119 <br />