Laserfiche WebLink
Environmental Health Department <br />Total Attendance:Average Age: <br />Yes <br />E2umpsters: <br />APPLICATION <br />1.event: <br />2. <br />responsible for meeting California State <br />Event Coordinator: Date: <br />5. <br />6. <br />5. <br />6. <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 />.Yes <br />Yes <br />2. <br />3. <br />4. <br />Submit the following to the Environmental Health Department two weeks prior to the <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 />SAN JOAQUIN <br />— COUNTY— <br />Greatness grows here. <br />Name of Event: <br />Date(s) of Event: <br />Location: H 1-4^____________ <br />Event Coordinator (Name): fYtTIC <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />I &Time t )f Event: <br />r (Name): L’l IU 1/ IQ K-) 'Telephone: ^Y)| H? 1 U tj 1/ <br />I Average Age: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />□ No . j <br /> No <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />LE INFORMATION <br />4 UlTf/PtN C-&KT <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 EnvironmentgiHHealth Department policies and procedures. <br />Pm ni Hazeltori Avenue I StWon, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />07/3/17 Pa9e 1 of 11 temp EVENT APP <br />TEMPORARY EVENT APPLICATION 0, <br />To be completed and signed by Event Coordinator, then returned to the Environmental Hea^^^rt^nt wiflW <br />of the Food Vendor’s Applications no later than two weeks prior to event