Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <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: 0►i <br /> 2. Date(s) of Event: D ,QIal� Lq���(� Time of Event: :o��lYln-3.O+DPIYVt� <br /> 3. Location: i <br /> 4. Event Coordinator(Name): �Dont�.yle� Telephone: (�) 59q. 75149 2a°i.4g9.L956 <br /> {[L I>I) <br /> Mailing Address: D+S. S"hDCL*D Au _ y_�an+n CA 'I53`co <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: 15DD Total Attendance: 6000 Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes �o <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes VNo <br /> 3. Are janitorial facilities available: VYes ❑ No <br /> 4. Number of toilets provided: I S <br /> 5. Name of sanitary garbage disposal company: C.t~t'rt 0"�' 4 bhL Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: IM uS+ hILL41 0_;fi{C_ <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$172 <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 /> • $172 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$774.00 <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 Coordinator: _D, Date: 2 <br /> CE 0-¢1 Pa" CVMLVA6 r H►1M ert4p- <br /> 1868 E. Hazelton Avenue I 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 /> 07/0112024 <br />