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GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: 6.Total Attendance, <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2.If the event isjjelected for inspection, the Event Coordinator will be billed for inspection time: <br />XLEvent Coordinator:Date: <br />Page 1 of 11 TEMP EVENT APPEHD 16-02 <br />08/01/16 <br />I understand that as a temporal <br />standards and the EAvironmentaK <br />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 $139z <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Name of Event.J ________________ <br />Date(s) of EvehL-^VA \3 <br />Location: <br />c^vent coordinator, I am responsible for meeting California State <br />leajth Department policies and procedures. <br />Id <br />■LINCOLN CfrWT&P- UV&. &V£NTS ,C/ML^W <br />E vehL^-^^-WZ)4 ,^mV\ Event:_ If - <br />UKICOLN ceNT&RTACfftC ATfeeKmMllOltPPt' <br />Event Coordinator (Name):WA TelephoneM HTi- 4 WT <br />Mailing Address: <br />Number of Food Booths: ~J <br />Approximate attendance at peak time ZlDQO <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 .. <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd •■'C-'L 2. 8 201/ <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 />• .^!-T39 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 ($208150 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 />^1 Yes No <br />£3, Yes No <br />jS^Yes No <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: tvl WM SlZ>pe-r ? pPRD L <br />Name of sanitary garbage disposal company: AL1A€D Number of dumpsters: |X-) <br />Method of disposal of liquid waste for food booths: W/A