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GENERAL EVENT FILE INFORMATION <br />Name of Event:1.\—y,' V-< <br />2.L. <br />3. <br />4. <br />5. <br />6.Average Age: Q-A~~ <br />UTILITIES <br />1. <br />2. <br />3. <br />4.V-y-v i <br />5.5 <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />Page 1 of 11EHD 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 />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental HealJIp Department policies and procedures. <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 <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 /> No <br />0Ves <br />&Yes <br />OYes <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 />Time of Event:_ <br />■v <br />Approximate attendance at peak time: <br />i.■^5 <br />-Total Attendance: <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 />TEMP EVENT APP <br />Date(s) of Event: ______■At.Ja <br />Location: _______) L S ' A <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: <br />A- ■ & <br />; L-t- <br />H A I. <br />II L - O Arv-~ — A*- . <br />____Telephone: ~ l\ <br />I <br />Number of dumpsters: HT;/ <br />X. V-A V'-f' G>\ Vs. L' C-< <br />nr <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: S C 2— <br />Name of sanitary garbage disposal company: < ,■ - J > <br />Method of disposal of liquid waste for food booths: A -Cat Av <br />i cA c r <br />•3 j <br />7 tv