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�puiN <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> cP. 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: T I-e (d an e7 l C t r Dat- ,, <br /> 2. Date(s)of Event: LAY) CJF + ( t 0 Time of Event: 7 a+ry) 2 p� fn, <br /> 3. Location: 1 � f6 te a n f Z 5 l- K k c A ti uiv �� jL 416) <br /> 4. Event Coordinator(Name): m-ee)hC2/1 LCM- Telephone.- (2(1 �j&& t'o2a� <br /> Mailing Address: -P, G • bbx d xq-8 L6c6 , CA <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: 0 Total Attendance: CC Average Age: �&M I I QS <br /> -tuxtei V e�5 i k 1 54 <br /> UTILITIES ���v�✓�t�� <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: ,l <br /> 5. Name of sanitary garbage disposal company: py� tU d_1 Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: yerdff (av l/I ob'-yvsz -6­o4 r -x` <br /> APPLICATION D C I rl Ki+z,hP,*) {- f� <br /> S a1414S <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 /> (J .< ,� / <br /> Event Coordinator. j��'7 �- / 'Ifir— Date: 7 1301 I <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 7/28/10 <br />