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GENERAL EVENT FILE INFORMATION <br />1.Name of Event: <br />2. <br />o3. <br />4. <br />5. <br />Total Attendance: J, <Q<4>c> Average Age: /6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />TEMP EVENT APR <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 />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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />EHD 16-02 <br />OR/M/IS <br />Date(s) of Event: __ <br />Location: ____/ 0 I <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 />CctV^Number of dumpsters:__L <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <br />bjl <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: ~ c <br />'0-Yes No <br />''jZLYes No <br />■^.Yes No <br />O C</ tZ< <br />I - <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Enyf?onmental Health Department policies and procedures. <br />Event Coordinator^/ <br />Page 1 of 11 <br />RiiiiWkH <br />San Joaquin Count <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/eh/r£g <br />5 t 2-0 l~l Time ofEvent:. <7 ' P-.-H 1 <br />Event Coordinator (Name): J Telephone: (Z-f?'?) ~ 3 p 2. 7 <br />Mailing Address: 7 /I/4? uhTv (2A <br />Number of Food Booths:_____ <br />Approximate attendance at peak time: