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P. 3No. 4823Sep. 28. 2017 9:51AM <br />To of the Food Vendor's Applications no later than two weeks prior to event <br />600 600 <br />UTILITIES <br />3 <br />1. <br />2. <br />Date: <br />Page 1 of 11 <br />1- <br />2. <br />3. <br />4. <br />5. <br />6. <br />0 Yes <br />{3 Yes <br />QYes <br /> No <br /> No <br /> No <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Total Attendant^ <br />TEMPORARY EVENT APPLICATION <br />be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <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 />application <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 $125 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time. <br />• $125 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 ($183 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 laterjhan two weeks prior to the <br />event. <br />Average Age. I 35 ; <br />GENERAL EVENT FILE INFORMATION <br />Name of Event- Girls Ni9ht Qut! Witches and Broomsticks <br />Date(s) of Event: October 20, 2017 Time of Event: 6:0Qpm-8:00pm <br />Location: Downtown Plaza (6th Street and Central Ave.) Tracy, CA 95376------ ----- <br />Event Coordinator (Name): Jolene Jauregui .Telephone: (209 831 <br />Mailing Address: 333 Civic Center Plaza, Tracy CA 95376--------------------------------------- <br />Number of Food Booths: 1 <br />Approximate attendance at peak time: <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: 6 ______— ----- <br />Name of sanitary garbage disposal company: Tracy Disposal Service Number of dumpsters: <br />Method of disposal of liquid waste for food booths: N/A <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: 10 ,1^0_________________ Date: — -El------------------------ <br />Received Time Sep. 28. 2017 9:50AM No. 2372 <br />iu