Laserfiche WebLink
GENERAL EVENT FILE INFORMATION <br />1. <br />Average Age: 50175100 <br />UTILITIES <br />APPLICATION <br />1. <br />(Exempt - see attachment) <br />2. <br />Date: <br />Page 1 of 11EHD 16-02 <br />2. <br />3. <br />4. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />S Yes No <br />0 Yes O No <br />0 Yes No <br />3 <br />TEMP EVENT APP <br />ED <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 />Name of Event: <br />Date(s) of Event: <br />Location: _____ <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths:No booths - use Social Hall <br />Approximate attendance at peak time: 100 Total Attendance: <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 gal <br />Method of disposal of liquid waste for food booths: T"° double sinks cans <br />Escalon United Methodist Church Omelet Dinner <br />April 16, 2016 Time of Event:4:30 - 7;00 p.m. <br />Escalon Methodist Church <br />K. Harris/J. Parsons^Telephone: ( ) ?nQ-838-?792 <br />2000 Jackson Avenue, Escalon, CA 95320 <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. <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 />T----------- <br />San Joaquin Coun «/ r <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/ehd TVSE^v <br />Event Coordinator: