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SANJOAQUIN p <br /> Environmental Health Department <br /> COUNTY D <br /> �-:tIF.•�+' Gr2QtnP$5 yr4rY5 hirr@, <br /> MAY o r 2021 <br /> TEMPORARY EVENT APPLICATIONNIVIRONMENTALH <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Healthp&W��Fr� ft> 9lTTH <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 Concprf 6erjes <br /> 2. Date(s)of Event imel of Event: tip:30 — 1 O(7 <br /> 3. Location: Y' <br /> 4. Event Coordinator(Name): Y Inf-fie, W one: 203 7tp 1 - 56 <br /> Mailing Address: 1621W E. ' 5 <br /> 5. Number of Food Booths: 1 <br /> 6. Approximate attendance at peak time: 34 Total Attendance: 3�� _Average Age: 5_ <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: XYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: XYes ❑ No <br /> 3. Are janitorial facilities available: XYes ❑ No <br /> 4. Number of toilets provided: . (P 5. Name of sanitary garbage disposal company: G 1�1f1 Wa 5+P�Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: n <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 /> • $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 a <br /> minimum three-hour overtime rate of$684.00 <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 Coordinat Dater <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 0614 9119 <br />