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Name of Event:1. <br />2. <br />3. <br />4. <br />5. <br />J D6.Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <br />Page 1 of 11EHD 16-02 <br />7/28/10 <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 />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 Count' <br />ENVIRONMENTAL HEALTH DEF. ..<TMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />Time of Event:_ <br />P c jjter <br />nt policies and procedures. <br />LP. - /h - <br />TEMP EVENT APP <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 Environ mental Health Depart, / / x' A /I/ <br />Approximate attendance at peak time: OC) <br /> Yes 0 No <br /> Yes P No <br /> Yes !3 No <br />w <br />- VP~ <br />/A —Telephone: _ <br />O tv) 0x2 <3 <br />GENERAL EVENT FILE INFORMATION <br />Uc^lley <br />Date(s) of Event: Q) Q C f o) / <br />Location: Ovckqrc/ UcyJ/-€y <br />Event Coordinator (Name): ! TJcz K H <br />Mailing Address: <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: r . <br />Name of sanitary garbage disposal company: Oil "4 (J~f Number of dumpsters: *0 <br />Method of disposal of liquid waste for food booths: 4-OOCT ( J P pjclo Uj / / / c, <br />bj 14-K —j'kc <br />Total Attendance: s.