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GENERAL EVENT FILE INFORMATION Name of Event:1. 2. 3. 606-1781 (..I Parsons)4. 5. Average Age: 506. UTILITIES 1. 2. 3. 4. 5. 6. APPLICATION 1. 2. Date: Page 1 of 11 received APR 0 4 2G18 EHD 16-02 08/01/16 Yes Ex] Yes Hr Yes No No No Submit the following to the Environmental Health Department two weeks prior to the event: a) Temporary Event Application b) Application Review Fee of $139 (Exempt - see attachment) c) Temporary Food Vendors Applications for each booth d) Temporary Event Site Plan e) Food Vendor List TEMPORARY EVENT APPLICATION To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all of the Food Vendor’s Applications no later than two weeks prior to event NOTE - Same as previous years - food provided - no booths - using church kitchen, (per Jeff C.) If the event is selected for inspection, the Event Coordinator will be billed for inspection time: • $139 per hour (weekdays 8:00 am to 5:00 pm) • After regular business hours (weekday, weekends and holidays) the inspection is charged at the hourly rate, calculated at one and one half times ($208.50 per hour) Escalon United Methodist Church Annual Omelet Dinner_________ Saturday, April 28, 2018 Time of Event: 4-30 pm- 7-00 p m 2000 Jackson Avenue, Escalon, CA_____________________________ San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd u:s:a;«T. This application is to be completed and signed by the Event Coordinator, then returned to the Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the event. Is potable water supplied and available for each food vendor: Is electricity supplied and available for each food vendor: Are janitorial facilities available: Number of toilets provided: Three (3) Name of sanitary garbage disposal company: Gilton Number of dumpsters: Four - 90 gal. Method of disposal of liquid waste for food booths: Two double sinks cans I understand that as a temporary event coordinator, I am responsible for meeting California State standards and the Environmental Health Department policies and procedures. Event Coordinator: Date:C Tya /c------ TEMP EVENT APP Date(s) of Event: Location: _____ Event Coordinator (Name): K. Harris/J. Parsons Telephone: (209 Mailing Address: 2000 Jackson Avenue, Escalon, CA 9320 Number of Food Booths: No booths - event is held in Social Hall of church Approximate attendance at peak time: 90 Total Attendance: 140