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S A NJ OA Q U I N Environmental Health Department <br /> COUNTY <br /> Greatness : . , s here. <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: <br /> 2. Date(s) of Event:(a g Time of Event: <br /> 3. Location: b-i% o, r S,-?. <br /> 4. Event Coordinator(Name):_n&V_.oL. �_v�e ti� Telephone: (ZJJT1 to\ —SSS7 <br /> Mailing Address: 6•21m <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: 100 Total Attendance: '3 OO Average Age: 5D <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor-, es ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Wes ❑ No <br /> 3. Are janitorial facilities available: [34s ❑ No <br /> 4. Number of toilets provided: ` t 1 V 0.,we\ 1 I <br /> 5. Name of sanitary garbage disposal company: G l �`�co - SUTA l-�&Number of dumpsters: 1 <br /> 6. Method of disposal of liquid waste for food booths.- <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$152 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site flan <br /> e) Food Vendor List <br /> 2. 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, l am responsible for meeting California State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: �` �-^"� Date: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EH7 16-02 Page 1 of 11 <br /> 0713/17 TEMP EVENT APP <br />