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SANJOAQUIN Environmental Health Department <br /> J <br /> TEMPORARY EVENT APPLICATION ENV,R UN 172019 <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health [5� rakLtf)y�l �r <br /> of the Food Vendor's Applications no later than two weeks prior to event RV/C H <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: P16"14/i e 41 Till Pon- sa <br /> 2. Date(s) of Event: 6 Z -2- - l C1 Time of Event: `c%C � G 0 <br /> 3. Location: M i rA 6 K___1 0201 6/n__ <br /> 4. Event Coordinator(Name): ; �_�,�Y 6ZIZC-S'tl—%Lay Telephone: Zcq y06 '-R Z� <br /> Mailing Address: &6 �5- y it)as b 0 i lL • 9 7-6 Cr r,RQI t` C�1 <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: / Average Age:S <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: XYes ❑ No <br /> 3. Are janitorial facilities available: eEg.Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <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, I am responsible for meeting California State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: Date: L <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ( F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3/17 <br />