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Name of Event:1. <br />2. <br />3. <br />Telephone:4. <br />5. <br />Total Attendance: |OOQ6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <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 />j/y/ii’ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 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 ($228 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 Department policies and procedures. <br />SAN JOAudlN <br />)------COUNTY------- <br />Greatness grows here. <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: z'7 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths:/J/f '/t' <br />0Yes O No <br />0 Yes No <br />QVes n No <br />Number of dumpsters: 3 <br />Approximate attendance at peak time: | 'L.Average Age: <br />GENERAL EVENT FILE INFORMATION <br />L O O ok 1 <br />Date(s) of Event: ■4 I N |\4> Time of Event: <br />Location: \~4 U \-Q\oh<CC> 4~C AL-^.~V <br />Event Coordinator (Name): <br />Mailing Address: tY\\\S A\aJI. <br />Number of Food Booths: I