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D <br />SEP 2 2 2016 <br />1. <br />2. <br />3. <br />4. <br />5. <br />Average Age:Total Attendance:6. <br />No <br />/7 2. <br />3. <br />I4. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />TEMP EVENT APPPage 1 of 12EHD 16-02 <br />7/14/15 <br />I understand that as a temporary event coordinator, I am responsible for meeting California State standards <br />and the Environmental Health Department policies and procedures. <br />ENVIRONMENT HEALTH <br />PERMIT/SERVICES <br />San Joaquin Cour <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/ehd <br />This application is to be completed and signed by the Event Coordinator, then returned to the Environmental <br />Health Department with all Food Vendor’s Applications no later than two weeks prior to the event. <br />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 />5. <br />UTILITIES Is potable water supplied and available for each <br />food vendor: Yes <br />1. <br />GENERAL EVENT FILE INFORMATION <br />’Sbpe.r <br />Time of Event: <br />Telephone: (^y) 3c? / - 76"^ o <br />, s-tvc k- ton , <br />Name of Event: <br />Date(s) of Event: /O J8// (p <br />Location: VJ < <br />Event Coordinator (Name):^”7^ <//l£ <br />Mailing Address: 6^3-33 61C AaJHL <br />Number of Food Booths:' <br />Approximate attendance at peak time: <D <br /> No <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: Yes No <br />Number of toilets provided: ' <br />Name of sanitary garbage disposal company: I Number of dumpsters: AjOdsVG VOO <br />Method of disposal of liquid waste for food booths: <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 />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 $T39-^ \ <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />3 Comer i