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o <br />GENERAL EVENT FILE INFORMATION <br />1. <br />3:00PM to 9:00PM2. <br />3. <br />4. <br />5. <br />6.Total Attendance: Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />Page 1 of 11 TEMP EVENT APPEHD 16-02 <br />08/01/16 <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 />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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />Q Yes <br />0 Yes <br />Q Yes <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <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 />Date: A/j '/ _______________ <br />Name of Event: Dia de los Muertos, City of Lodi <br />Date(s) of Event: October 29. 2016 Time of Event:. <br />Location: Hutchins Street Square 125 S. Hutchins Street, Lodi. CA 95240 <br />Event Coordinator (Name): Anne Poggio / Jeff Hood Director Telephone: ( 20^ 333-6735 <br />Mailing Address: 230 W, Elm Street. Lodi CA 95236 <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />A? <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: 7 3 <br />Name of sanitary garbage disposal company: Waste Management Number of dumpsters: <br />Method of disposal of liquid waste for food booths: UfoutAa crp-g-l <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/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