Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> ~ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> `' FORS P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <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 Applic tions no later than two weeks prior to event <br /> GENERAL EVENT FILE I ON <br /> 1_ Name Event: <br /> 2. Date(s)of Eve Time of Event:IF <br /> 3_ Location: �,ND x fova 4-A • q 6Ie <br /> 4. Event Coordinator(Name): Telephone: gCR S4S — I <br /> Mailing Address: I1 CN> <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: _Total Attendance: �>� Average Age: -b <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [JYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: VYes <br /> s El No <br /> 3. Are janitorial facilities available: ❑ No <br /> 4. Number of toilets provided: S <br /> 5. Name of sanitary garbage disposal company: 4 aA<X 4-'-t -lumber of dumpsters: <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$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 Department policies and procedures. <br /> Event Coordinator: Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />