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N SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �. P 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd <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 /> 1. Name of Event: W an RL i r Da L_ <br /> 2. Date(s)of Event: tYI Sr, ( Time of Event: rn • <br /> 3. Location: Sfr, G�: l Z 5 1411t,t C44 NIL <br /> 4. Event Coordinator(Name): m.,0__6)h6Ln LC OOC Telephone: (2CI ?j49& • 1 <br /> Mailing Address: bu d, 7's_ LLkai , CA: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: , 0 0 Total Attendance: L'C; Average Age: l.rn I I <br /> Cl i� h iC4 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: es ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Yes ❑ No <br /> 3. Are janitorial facilities available:22 [/Yes ❑ No <br /> 4. Number of toilets provided: _J <br /> 5. Name of sanitary garbage disposal company: t641G Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: w1II d,lyasb b4- <br /> �-�vl� �r in 12;+-�►�s c�-{-- {-�vr�t�i fps �`���-r� <br /> APPLICATION <br /> 1. 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. 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 /> 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 Health Department policies and procedures. <br /> Event Coordinator: Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 7/28/10 <br />