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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: 2-6.Average Age: <br />2. <br />3. <br />4. <br />WO fervicet 2.5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <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 $152 <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <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 <br />[h <br />H CCU______Telephone: (4M) ~ 3 <br />dlOGROft , CA ASZkZ <br />[Zfves <br />tzfves <br />[2fYes <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />SANJOAOUIN <br />COUNTY <br />Greatness grows here. <br />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 a <br />minimum three-hour overtime rate of $684.00 <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. f / <br />I understand that as lia temporary levent coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Dep^ment policies and procedures.py <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: 4 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: BflK <br />CCH( football ________________ <br />Date(s) of Event: j G /l^ ( A / j JO J iV/Eqne of Event: (j2 pm <br />Location: ifChflfil_____________ <br />Event Coordinator (Name): Chri-ftVph^f MtCCl <br />Mailing Address: 2^2^ Lfi <br />Number of Food Booths: _| <br />Approximate attendance at peak time: 2-00