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U -'i/3 <br />11L <br />RECEIVED <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Average Age: 50175Total Attendance: <br />UTILITIES <br />-Qr a <br />A V <br />APPLICATION <br />1. <br />(Exempt - see attachment) <br />2. <br />Event Coordinator: <br />TEMP EVENT APPPsinft 1 nf 11run n*» <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />REC5San Joaquin Coun ■ i <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-623: <br />Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sg^org/ehd <br />TEMPORARY EVENT APPLICATION <br />APRoUIcWleted and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />ENVIRONMENTAL HEALTH <br />'^gener^event file information <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 />\ Date. — <br />Name of Event: <br />Date(s) of Event: <br />Location: _____ <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths:No booths - <br />Approximate attendance at peak time: <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: Three ( 3 ) <br />Name of sanitary garbage disposal company: Gilton _ Number of dumpsters: Four 9 0 ga. <br />Mpthnd of rti<;pr>«;al of liqniri waste for food booths:Tvo double sinks cans <br />0 Yes No <br />0 Yes No <br />Yes No <br />Escalon United Methodist Church Omelet Dinner <br />4pril ^7- Time of Event:4:30 - 7:00 pan. <br />Escalon Methodist Church <br />K. Harris/J. Parsons^Telephone: ( ) ?nQ-8?R-2792 <br />2000 Jackson Avenue, Escalon, CA 95320 <br />use Social Hall __ <br />100 <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 NOTE - Same as previous years - food <br />e) Food Vendor List provided- no booths - using <br />church kitchen. . (per Jeff C.) <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 />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.