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JUN 3 0 2018 <br />GENERAL EVENT FILE INFORMATION <br />Name of Event:1. <br />2. <br />3. <br />4. <br />f <br />5. <br />2.5*0Total Attendance:Average Age:6. <br />UTILITIES <br />1. <br />2. <br />3.es <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />TEMP EVENT APPEHD 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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />ENVIRONMENT HEALTH <br />^ERMIT/SERVICES <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 />Page 1 of 11 <br />A-Number of dumpsters: 3~^c-?<rtr<3L. <br />‘-eV’ . <br />Q'Yes <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. <br />J ______ Date: (p l3Ol Jlp <br />A-ll <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 />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/ehi <br />'i a fioc <br />Date(s) of Event: <br />Location: 1 <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 />Is potable water supplied and available for each food vendor: | <br />Is electricity supplied and available for each food vendor: I <br />Are janitorial facilities available: i <br />Number of toilets provided: 12-______ <br />Name of sanitary garbage disposal company: Vl qsVc- <br />Method of disposal of liquid waste for food booths: Vig-6-Vz- <br />r~ Ljexcr-S <br />~__(lp>________________________________Time of Event: fDpM <br />Event Coordinator (Name): Telephone: (2-°^ 33^- ^8*7/ <br />Mailing Address: 1'2- 5" S. IrVvtV"A6 \S k | £2 <br />Number of Food Booths: O <br />Approximate attendance at peak time: