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Environmental Health Department <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Average Age: % *1Total Attendance: <?C26.Approximate attendance at peak time: <br />UTILITIES <br />1. <br />2. <br />3. <br />44. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: 3 7 ~~ / 9^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 />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: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />Date(s) of Event: <br />Location: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENTAPP <br />07/3/17 <br />7 s. <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 />-p ■ — <br />cdLwith all <br />H Yes No <br />El Yes Q No <br /> Yes [TfTJo <br />SANJOAQUIN <br />-----COUNTY----- <br />Greotness grows here. <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental HeaS <br />of the Food Vendor’s Applications no later than two weeks prior to even <br />GENERAL EVENT FILE INFORMATION <br />__ <br />y-/.?'■ , ___Time of Event: <br />Event Coordinator (Name): /> <7 Telephone: (X<^ ^9 <br />Mailing Address: (Z yffZ, <br />Number of Food Booths:A* ///__________ <br />feNV 0 7 70,9