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rc-5) <br /> Ece"D <br /> ,A ..__. <br /> SAN JOAQUIN COUNTY <br /> Chi; ENVIRONMENTAL HEALTH DEPARTMENT MAY 12 2017 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orq ehcP�MMER AVL He4t� <br /> 10Eg <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. Time of Event: S'3+1 J_ tM <br /> 3. Location: R► <;` w L <br /> 4. Event Coordinator(Name): Telephone: {Jolt +-t'2-.b t <br /> Maiiing Address: I1 c)t> <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: '�00 Total Attendance: �3tAO Average Age' <br /> UTILITIES <br /> c <br /> 1. Is potable water supplied and available for each food vendor: EjYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: VYes <br /> s ❑ No <br /> 3- Are janitorial facilities available: ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: 4'C[�.n ��.�WaS'T`cNurnber 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 08101118 TEMP EVENT APP <br />