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SAKJ0A0UIN Environmental Health Department <br /> COUNTY <br /> Greatness grows 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: r CO✓�%Z' n,< <br /> 2. Date(s) of Event: Time of Event: 6,30 — It W� <br /> 3. Location: 1Vr� o•..) ��'�` <br /> 4. Event Coordinator(Name)_ NV-,1oL- L%3 Telephone: (Z -7 (a\ <br /> Mailing Address: _) ?.L, -5- <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: �jpp Total Attendance:. "3 DO Average Age: 5D <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: S;I es ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Wes ❑ No <br /> 3. Are janitorial facilities available: t_gAs ❑ No <br /> 4. Number of toilets provided: — Jr � u p.�*Jo` <br /> 5. Name of sanitary garbage disposal company: ��-:!O— Sofa li-�,��•Number of dumpsters: l <br /> 6. Method of disposal of liquid waste for food booths: y' s�vti `'• eta ��v �� �ti <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 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 /> 0 $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 /> Event Coordinator: �� Date: ! Q 1! <br /> 1868 E. Haze€ton Avenue I Stockton, California 95205 J T 209 468-3420 1 F 209 464-0138 ) wvvw.sjcehd.com <br /> EHD 16-02 Page 1 of 11 <br /> 0713117 TEMP EVENT APP <br />