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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Average Age: Total Attendance: Q£>O6. <br />1. <br />2. <br />3. <br />4. <br />/5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />Date(s) of Event: <br />Location: i <br /> No <br /> No <br /> No <br />a) <br />b) <br />c) <br />d) <br />e) <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 />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $152 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />GENERAL EVENT FILE INFORMATION <br />1. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />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 the <br />hourly rate, calculated at one and one half times ($228 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:/ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APR <br />07/3/17 <br />[JjYes <br />^Yes <br />QjYes <br />UTILITIES <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: / <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: i <br />c/ | kr TOI f p 1 ________ <br />'em: Time of Event: <br /> <br />Event Coordinator (Name): /K, Telephone: <br />Mailing Address: b kJr S s y- CA <br />Number of Food Booths: / <br />Approximate attendance at peak time: /GO