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No. 4226 ?. 6Apr. 26. 2016 5:52PM <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />600 35Total Attendance: 600 Average Age:Approximate attendance at peak time:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />3Number of dumpsters;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 $125 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />[2 Yes <br />Q Yes <br />a Yes <br /> No <br /> No <br /> No <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 />San Joaquin County <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 <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $125 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 ($183 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 />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental HealthiDepartment policies and procedures. <br />J(Wj Date: <br />TEMP EVENT APP <br />Name of Event: Girls Ni9ht Qut! An Evening AT Gatsby's <br />Date(s) of Event: May 6, 2016-|-irrie Of Event: 6:00pm-8:00pm <br />Location: Downtown Plaza (6th Street and Central Ave.) Tracy, CA 95376 <br />Event Coordinator (Name): Jolene Jauregui Telephone: (209 831-6213 <br />Mailing Address: 333 Civic Center Plaza, Tracy CA 95376 * <br />Number of Food Booths: <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: 6 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: N |/V <br />EHt> 16-02 Paga 1 of 11 <br />Received Time Apr. 26. 20 1 6 6:06PM No. 0737