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FILE COPY <br /> .N _. f�'rY�•� SAN, UAQUIN o <br /> ;, ^� Environmental Health a a�fiment <br /> r COUNTY <br /> ra4iFc� ' Greatness grows here. A � <br /> �NVI"R PR 2 52018 <br /> TEMPORARY EVENT APPLICATION P RMMeN-r4tH, <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health Department'i�lf(�t#S r j <br /> of the Food Vendors Applications no later than two weeks prior to event <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: Fruit&Veggie Fest <br /> 2. Date(s) of Event: April 27, 2018 Time of Event: 10am-2pm <br /> 3. Location: La Superior Mercados 3310 E Main Street, Stockton, CA 95205 <br /> 4. Event Coordinator(Name): Tivoli Walker Telephone: (209) 468-8637 <br /> Mailing Address: 1601 E_-Hzzelton Avenue, Stockton, CA 95205 <br /> 5. Number of Food Booths: 2 J <br /> 6. Approximate attendance at time: 50 Total Attendance: 200 Average Age: 18+ <br /> UTILITIES \ <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes ® No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes ® No <br /> 3. Are janitorial facilities available: ❑ Yes ® No <br /> 4. Number of toilets provided: None <br /> 5. Name of sanitary garbage disposal company: NIA Number of dumpsters: NIA <br /> 6, Method of disposal of liquid waste for food booths: NIA <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$152 <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 /> • $152 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 ($228 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, 1 am responsible for meeting California State <br /> standards and thejEnvironme a Health Department policies and procedures. <br /> Event Coordinator: Date: f� b <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EH❑16-02 Page 1 of 11 TEMP EVENT APP <br /> 0713117 <br />