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SAN JOAQUIN COUNT <br /> e cr <br /> ENVIRONMENTAL HEALTH DEPARTMENT o <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> \4`oRa� Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd D <br /> AUG r g.1016 <br /> TEMPORARY EVENT APPLICATION PERN1Nr sE T <br /> RR����HEA(tH <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with'Me, <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: 1 '16A C-Oct F�6r DLL / _L <br /> 2. Date(s) of Event: K\ JA P Time of Event: 60 Q, m , 1 6 n��l <br /> 3. Location: II +r�I�S sof t Ct(Ra�� 195 .S �tc..h;t/tS_ e5 t , chi, QS,cl D <br /> 4. Event Coordinator(Name): ( /�' h.P, Led Z Telephone: 3�� i ao2;�- ry 1 <br /> Mailing Address: 0 02 S Ste( ` <br /> 5. Number of Food Booths:71 (`C-Q k4-�Z-�-t <br /> 6. Approximate attendance at peak time: CC) Total Attendance: C)O Average Age:G� _( l I[M (1�$ <br /> UTILITIES �/ <br /> 1. Is potable water supplied and available for each food vendor: CE Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor. dYes ❑ No <br /> 3. Are janitorial facilities available: l'Yess I❑ No <br /> 4. Number of toilets provided: ! V1 , IL t,c;6 W CVO 02 <br /> 5. Name of sanitary garbage disposal company: , yL Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: sx, f y),A�4 <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$130 <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 /> • $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 /> 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 vironmental Health Department policies and procedures. <br /> Event Coordinato . W, U Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 7/14/15 <br />