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°�Ru�~' SAN JOAQUIN COUNT' a <br /> -F' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> k � <br /> �. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd AUK 22016 <br /> ENVIlIONtYI <br /> PERMITI ERVi�E�T� <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: En c>(� St_lmmec ?)cxn c I <br /> 2. Date(s)of Event: RU to Zo no Time of Event: CO.00 m- D•'DD <br /> 3. Location: 1 C) � TNr 11er �oq�Il- �..DcQ t C qS2 y-Z ,or� l Lakes <br /> 4. Event Coordinator(Name): Senn+_kr \A,mv-1 Telephone: (209333 - (.vg`1 I <br /> Mailing Address: )2-5 S. 1 cA k- Q • 9S 2'-}O <br /> 5. Number of Food Booths: 2-- <br /> 6. Approximate attendance at peak time: 160 Total Attendance: ) 6 0 Average Ag I`'E'-1-1 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: B e' ❑ No <br /> 2. Is electricity supplied and available for each food vendor: VYes <br /> s ❑ No <br /> 3. Are janitorial facilities available: ❑ No <br /> 4. Number of toilets provided: 12- <br /> 5. Name of sanitary garbage disposal company: W 0,%hG Manuaunuy� Number of dumpsters:2 'ZP%6rcL. <br /> 6. Method of disposal of liquid waste for food booths:\► 541-k ►on qxv NC4_. <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 Environmental Health Department policies and procedures. <br /> Event Coordinator: Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 7/14/15 <br />