Laserfiche WebLink
s 2� ARzsVt:)402 <br /> SA N 10AQ U I N Environmental Health Department. <br /> COUN I Y <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 /> GENERAL EVENT FILE INFORMATION I <br /> 1. Name of Event: Q (O' Lsoorce— 'S �i \fa! <br /> 2. Date(s) of Event: :rune- 13}h 202 P Time of Event: 1 axn — -J_Fm <br /> 3. Location: 1 C) \,Aj Cod 1,uaY-d ve, 0 Q CIS" 3-1 <br /> 4. Event Coordinator(Name): 0. eSStA e_nc1u Telephone: (2vq) �St - 4�•IS <br /> Mailing Address: 3(-)a h�rr S l� l�3$ �P(a a g533 7 <br /> 5 Number of Food Booths: lFoocl TruCr— # (cjQ 4-hs <br /> 6. Approximate attendance at peak time; _gdt4 -Total Attendance: / 00 Average Age: <br /> UTILITIES V %10.h1e. <br /> Water is a-- a <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes No b Ut V p noiar5 w It br► <br /> 44)aYX <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes �NotiY Uw <br /> 3. Are janitorial facilities available: N'Yes FJi e c,�rr►Lti <br /> ❑ o <br /> 4. Number of toilets provided: y <br /> S. Name of sanitary garbage disposal company: a Sod+ g -Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: Very j a YS w' CkIS P 63QI lkc6ut'a( wrist n U <br /> APPLICATION <br /> I- 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$152 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List <br /> 2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br /> • $152 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-hour overtime rate of$684.00 <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 110 later then two eks 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 Environmental Health Department policies and procedures. <br /> Event Coordinator: Date: (9 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sjgEHD ov orglehd <br /> OV1y119 09 Pam 1 or 11 TEMP EVENT APP <br /> Qy t <br /> f <br />