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SAN JOAQUIN COUNTY �L�``�`�t► L <br /> `i ENVIRONMENTAL HEALTH DEPARTMENT IWAY 12 2gi? <br /> 1868 Fast Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:%,Mv.sjgov.org/ehd��RMM- TAL F1Cq�7f <br /> LRVIG,S <br /> TEMPORARY EVENT APPLICATION <br /> To be cornplated and signed by Event Coordinator, then returned to the Environmental Health Department%vith all <br /> of the Food Vendor's Applications no later than two weeks prior to event <br /> GENERAL EVENT FILE INFORMATION <br /> i. Name of Event: Lj G. <br /> 2. Date(s)of Event. (� V n Time of Event: } ,p <br /> 3. Location: s. C- <br /> 4. Event Coordinator(Namej:_ <br /> Nlailing Address: 1-1 e b xrAs:14c.n •tt -�_ _ <br /> 5. Number of Food Booths: I <br /> G. Approximate attendance at peak time:_ 3-!�Q--Total Attendance:_ �3x X:5— Average Age; <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor. Q/Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor. C�Y ] No <br /> Are janitorial facilities available: Yes ❑ No <br /> d. Number of toilets provided: -5- __ 1 <br /> 5. Name of sanitary garbage disposal company-. .r` ����W_eE -Number of dumpsters: 1 <br /> 6. Method of disposal of liquid waste for food booths: ,��.,,� r �-.�, : �-�- <br /> APPLICATION <br /> t. 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,cak Plated at nne and one!calf limes (S208.50 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 pLljor to the <br /> event. <br /> 1 understand that as a temporary event coordinator, I am responsible for meeting California State <br /> standards and the Environmental Health Depa tment policies and procedures. <br /> t <br /> Event C=dinstor- oc-,r � Date: J Ga a7- <br /> EHD 16-02 Page 1 of 11 TEMP EVEN i APP <br /> {18ID1M6 <br />