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SAN JOAQUIN COUNTY <br /> _ _..:,. D <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 0 9 2017 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> 'ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <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 r <br /> GENERAL EVENT FILE INFORMATION F , n /C /, �I d + <br /> 06i 6 <br /> 1. Name of Event: I L 11 ► C.. 61 v' ---- <br /> 2. Date(s)of Event: �1 x ,� + o 17 Time of Event: 10 Q m •— 3 t" "1 <br /> 3. Location: + c_ e_ �"►- 6 v ( a r c <br /> 4. Event Coordinator(Name): L!�i ► /i S�cl+(� Telephone: (�U j 9 f ci' <br /> Mailing Address: c.9t);.' t yt (a e Ycf h 1� YL <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: i-mot 3 Total Attendance: ly Average Age: <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: E.Yes ❑ No <br /> 4. Number of toilets provided: ?a <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$139 <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 /> • $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 /> 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 H e�,Department policies and procedures. <br /> Event Coordinator: ( �+� 'L -�t � Date: <br /> EHD 16-02 3�"Z 7`h� cu.,.-� Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />