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SAN JOAQUIN COUNTY ° <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95206-6232 MAY 3 j z016 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org <br /> RE'VMFNT <br /> I'ERM1T'/SERVICES <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: %jo+-'i' tl 11 J aw, 9 Time of Event: = O - 10,Oo <br /> 3. Location: q-- o, N (ae, s <br /> 4. Event Coordinator(Name): JOI-w �i►� �SuaaL� _ Telephone: -14 2 4. f <br /> Mailing Address: 1106 AVifr <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak ti e: OO Total Attendance: Average Ag <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: M Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: [ Yes ❑ No <br /> 3. Are janitorial facilities available: Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: Number 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$130 <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 /> C $130 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 ($195.00 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 /> ✓ 1 <br /> Event Coordinator: —t w +-� Date: <br /> EHD 16.02 Wage 1 of 11 TEMP EVENT APP <br /> 7114/15 <br />