Laserfiche WebLink
Environmental Health Department <br />2. <br />3. <br />4. <br />5 <br />Average Age:6. <br />2. <br />3 <br />4 S L.V. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator. <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 $156 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />K Yes <br />^jYes <br />JSjYes <br /> No <br /> No <br /> No <br />1868 E. Hazelton Avenue | Stockton, California 95205 j T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <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 />xM <br />Name of Event: <br />Date(s) of Event: ZS <br />Location: ____L o (Vv <br />If the event is selected for inspection, tne 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 inspection is charged at a <br />minimum three-hcur 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 EnvironmSnt^Health Department policies and procedures <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1.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: a* Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />LfcR f-.r-a-fT YS-e-e-V r/c-A______________ <br />CL 10, && Time of Event: SL'.QfX - <br />ka.kr- PafV-_______________________ <br />Event Coordinator (Name): Telephone: <br />Mailing Address: I & TO"pry T) V -< C- <br />Number of Food Booths: D <br />Approximate attendance at peak time: l7d/3>?d&i)Total Attendance: tZyGOd <br />SAN JOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />Date: