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GENERAL EVENT FILE INFORMATION <br />Name of Event: 1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: 55- 356. <br />UTILITIES <br />1. <br />2. <br />3. <br />134.HNumber of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time:2. <br />Date: Event Coordinator: <br />TEMP EVENT APPPage 1 of 11 <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 Enviroi <br />EHD 16-02 <br />7/14/15 <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 JU-30" j <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />• '^L^Tper 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 ($195.00 per hour) <br /> No <br /> No <br /> No <br />Yes <br />'S Yes <br />f^fYes <br />C.4Z <br />: JU, <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 <br />Date(s) of Event: <br />Location: ______t-o •' <br />San Joaquin County <br />Rte trfrR 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^ \ <br />MAY3°20!n <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departm'f^t^^^PlZ.Z/y <br />of the Food Vendor's Applications no later than two weeks prior to event <br />I ? <br />Event Coordinator (Name): I-L4U <br />Mailing Address: 2sHt-( d => <br />Number of Food Booths:~ 5Om. " <br />Approximate attendance at peak time: | 2-^ D Total Attendance: 5 5 U O <br />o I < <br />I Time of Event: Q : ^0 - (q Od <br />"TT-t-zx(LC _____ <br />-Telephone: (<?^() "7 1 <br />. CA ^5zh2