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GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />5. <br />Average Age: 50175Total Attendance:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />1. <br />(Exempt - see attachment) <br />2. <br />Date: <br />TEMP EVENT APR <br />EHD 16-02 <br />3. <br />4. <br />E Yes <br />0 Yes <br />0 Yes <br /> No <br /> No <br /> No <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 />APPLICATION <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $130 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan NOTE - Same as previous years - food <br />Food Vendor List provided- no booths - using <br />church kitchen. (per Jeff C. <br />a REC0VEO <br />San Joaquin County <br />Environmental Health Department 'U i <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />Gilton_________Number of dumpsters: Four 9 0 ga <br />Two double sinks cans <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_1 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <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 pnor to event <br />a) <br />b) <br />c) <br />d) <br />e) <br />If the event is selected for inspection, the Event Coordinator will be billed for*ins^Etfoh 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 thap two weeks 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 /> Date: -------------- <br />Page 1 of 11 <br />Escalon United Methodist Church Omelet Dinner <br />April 16, 2016 Time of Event:4:30 - 7:00 pun. <br />Escalon Methodist Church __ <br />K. Harr is/J. Parsons Telephone: ( ) ?nQ-fl3R_?-7Q? <br />2000 Jackson Avenue, Escalon, CA 95320 <br />u_se Social Hall_______ ___________ _ <br />100 <br />Event Coordinator: