Laserfiche WebLink
SANJOAQUIN Environmental Health Department <br /> CnU NTv- - <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: (71i- CA <br /> 2. Date(s) of Efv�e1nt:� A Time of Event: (a O� " I l} �J� 1''1 <br /> 3. Location: W <br /> 4. Event Coordinator(Name): 17 <br /> ,1 i e Telephone: (X f) <br /> Mailing Address: 1 r(e e. <br /> 5. Number of Food Booths: lk / <br /> 6. Approximate attendance at peak time: O 0 Total Attendance: dloo Average Age:a/— L7 0 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes 6o <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: .'�I <br /> 5. Name of sanitary garbage disposal company: r-l of✓'�h 1,a1'1t-t IC Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: rcic C JhP•l <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$156 <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 /> • $156 per hour(weekdays 8:00 am to 5:00 pm) <br /> • After regular business hours (weekday, weekends and holidays) the in ction is charged at a <br /> minimum three-hour overtime rate of$702.00 <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 /> _ <br /> Event Coordinator: � Date: <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 /> 06/19/19 <br />