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ailment <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />6. <br />1. <br />2. <br />3.A4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time:^ JA!(A <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br />0'No ptcbilC <br />Io <br />/Telephone: C <br />dwnkca, <br />Total AttendancQ^/TO-.-'^y)1 Average Age: <br />f * / W ---- f-------L------f <br />tif'' <br />E^Yes [ <br /> Yes ETn <br /> Yes [^Tno <br />Py of dumpsters: <br />3ths: <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 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 ($228 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 />UTILITIES <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: . 7 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />SAN JOAQUIN <br />-----COUNTY— <br />Greatness grows here. <br />Date(s) of Event: •_ <br />LocatiorE^fc C4/ <br />Event C<TOr<£ina^br <br />Environmental Health D^ar1 <br />TEMPORARY EVENT APPLICATION s <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departmenfw^afpS^^^ <br />of the Food Vendor’s Applications no later than two weeks prior to event ■ <br />GENERAL EVENT FILE INFORMATION . / / /) . a , f-D( Zhh.Z tftocr <br />Time of Event: