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EH®®) <br />APR 2 9 2016 <br />GENERAL EVENT FILE INFORMATION <br />11.Name of Event: <br />2. <br />3. <br />4. <br />4- <br />5. <br />- <4(56.Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />35.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />c^nmen <br />Event Coordinator:Date: <br />Page 1 of 11 TEMP EVENT APP <br />Total Attendance: <br />EHD 16-02 <br />7/14/15 <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 />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 />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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />^Yes <br />KYes <br />C^Yes <br /> No <br /> No <br /> No <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. I i <br />/ Za) <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $130 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 ($195.00 per hour) <br />:h Department policies and procedures. <br />Date: H <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 />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 <br />ENVIRONMENT HEALTH <br />PEIIMIT/SERVICES j <br />friers <br />Event Coordinator (Name):£_ <br />Mailing Address: Z <br />Number of Food Booths: 5 <br />Approximate attendance at peak time: <br />L<>4» ISeeT <br />Date(s) of Event: <br />Location: <br />cTr.ii* c-.S <br />Time of Event:_ <br />Lfckx- ___ <br />__Telephone: 74'7- LJ O <br />C , LoJl-. CA