Laserfiche WebLink
Mar. 4. 20 1 6 12:50PM GHI RARDELL I No. 2854 P. 2 <br />o <br />4. <br />5©OTotal Attendance:Average Age: <br />UTILITIES <br />INumber of dumpsters: <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />Page 1 of 11 TEMP EVENT APP <br />4. 2016 12:50PM No. 0539 <br />I understand that as <br />standards and the <br />5. <br />6. <br />1. <br />2. <br />3. <br />1. <br />2. <br />3. <br />4. <br />5. <br />.6. <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 />EHD 16-02 <br />IIM/14 <br />Received Time Mar. <br />Name of Event: <br />Date(s) of Event <br />Location: J ____________ <br />Event Coordinator (Name): Tlbl^ds ____’ - <br />Mailing Address: //// /h/C <br />Number of Food Booths:_______ <br />Approximate attendance at peak time: oSOO <br />^Yes No <br />O Yes J^No <br /> Yes J2[No <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/eh' <br />If the event is selected for inspection, the Event Coordinator will be billed'for inspection and travel 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 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 />a temporary event coordinator, I am responsible for meeting California State <br />EipvironmentalHealth Department policies and procedures <br />LmwW Da,.Wi6 <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: 62 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: hj <br />TEMPORARY EVENT APPLICATION ^,n 2oi6 <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Dep^pfe^j^^^aL <br />of the Food Vendor's Applications no later than two weeks prior to event Se,t^rn <br />general event file information <br />Event: W^rne of Event: <br />* »-►— . I 4 , <br />L______________Telephone: (Pl'Q