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Environmental Health Department <br />Z <br />APPLICATION <br />1. <br />2. <br />then returned to the <br />responsible for meeting California State <br />Event Coordinator: <br />5. <br />6. <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Tern porary Event Application <br />b) Application Review Fee of $162 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here <br />'n <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: Number of dumpsters: <br />Method of disposal of liquid waste for food booths: Nlft- <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 />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $162 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 $729.00 <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 />Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I wwwsiqov orq/ehd <br />06/29^23 Pa9e1Of11 ' TEMP E^ENT APR <br />Average Age: <br />Yes No <br /> Yes ^z^fNo <br /> Yes JZTno <br />Name of Event: V(\ 'AV)'?. _______ <br />Date(s) of Event: Q Time of Event: <br />Location: <br />Event Coordinator (Nameiry^PAlDTk Telephone: (2<jq A-'SXo ( <br />Mailing Address: 7 CVxeVYM TV^rrV-e CGtj CA,. <br />Number of Food Booths: <br />Approximate attendance at peak time: OQ Total Attendance: S OQ