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1. <br />2. <br />3.-r <br />4. <br />5. <br />/sod6.Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Page 1 of 11 TEMP EVENT APPEHD 16-02 <br />7/14/15 <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 />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" f <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br />^fves <br />Yes <br />jXf Yes No <br />Average Age: Lz* CJ <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 />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 />GENERAL EVENT FILE INFORMATION <br />Name of Event: fahoYAm Oo Awn <br />Date(s) of Event:_Tim- <br />Location: / 9 S, mmUl <br />Event Coordinator (Name): Lj flA- <br />Mailing Address: <br />Number of Food Booths:| _______ <br />Approximate attendance at peak time: | CO(j <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and th6 EnjvironmentakHealth Department policies and procedures. <br />Event Coordinator: Date: <br />San Joaquin Count <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 0 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.ang/ehd,"Sag'" <br />Time of Event:. - j2)-00(9^ <br />nc » COOlnt <br />___Telephone: T3ITJl \ WO <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:2!____________ <br />Name of sanitary garbage disposal company: \jZOPAv’ Number of dumpsters: 1 <br />Method of disposal of liquid waste for food booths: