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SAN JOAQUIN COUNT <br /> ( : ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232A14 ' 1 <br /> �Q LrzTiY Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s�gov.org/ f�ttjR3 4?Qp <br /> pFR4 SFR <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: Lodi Wine & Food Festival <br /> 2. Date(s) of Event: April 1, 2017 Time of Event: 2PM-6PM <br /> 3. Location: Lodi Grape Festival Grounds 413 E. Lockeford Street Lodi CA <br /> 4. Event Coordinator(Name): Lodi Grape Festival Telephone: (209) 369-2771 <br /> Mailing Address: P.O. Box 848 Lodi CA 95241 <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: 1,500 Total Attendance. 2,000 Average Age: 35 <br /> UTILITIES <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 ❑ No <br /> 3. Are janitorial facilities available: ❑X Yes ❑ No <br /> 4. Number of toilets provided: four permanent restrooms <br /> 5. Name of sanitary garbage disposal company: California Waste Number of dumpsters: 4 <br /> 6. Method of disposal of liquid waste for food booths: City Sewer <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 <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 /> • $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 the Environmental Health epa ment policies and procedures. <br /> Event Coordinator: _/%�� �'w Date: �/7/� <br /> EHD 16-02 age 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />