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P. 3No. 392 1Oct. 1 6. 2015 12:09PM <br />GENERAL EVENT FILE INFORMATION <br />600 Total Attendance; 600 35Average Age: <br />UTILITIES <br />APPLICATION <br />1. <br />2. <br />■I of 11 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />H Yes <br />[3 Yes <br />[3 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 />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 />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 />Event Coordinator: I. k <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: VW <br />Method of disposal of liquid waste for food booths: 1 U <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 (2183 per hour) <br />Name of Event: Gir,s Night Out! Witches and Broomsticks <br />Date(s) of Event: October 23. 2015 Time of Event: 6:00pm-8.Wpm <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 />Approximate attendance at peak time: <br />San Joaquin County RECEIVFR <br />Environmental Health Department i v cu <br />1868 East Hazelton Avenue, Stockton, CA 952O5-6230Q]' j e onir <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />environmental health <br />TEMPORARY EVENT APPLICATION PERMIT/SE™CES <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 (wo weeks prior to event <br />U Oft 14 <br />EHD 16-02 pAg6 1 _f : <br />Received Time Oct. 16. 2015 12:22 PM No. 9807 <br />Date: IQ| ISU15 <br />TEMP EVENT APP <br />Number of dumpsters: 3