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Environmental Health Department <br />.iba: <br />1. <br />2. <br />3. <br />Telephone: (tjoi-) t*z<x4. <br />5. <br />Average Age: IU ~~ (foTotal Attendance: <>o~~ 2006. <br />1. <br />2. <br />3. <br />4. <br />4~ <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: 0^- >7-Event Coordinator: <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 />rary event coordinator, I am responsible for meeting California State <br />al Health Department policies and procedures. <br />IS^Yes <br />0 Yes <br />fZlYes <br /> No <br /> No <br /> No <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br />grows here. <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 />SAN JOAQUIN <br />—COUNTY— <br />Greatne <br />5 site <br />■ <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 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 temf <br />standards and thefEnvironmei <br />Ij— <br />Event Coordinator (Name): c-ur<» <br />Mailing Address: <br />Number of Food Booths: _j <br />Approximate attendance at peak time: 2-6d <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: C^xi cz- As <br />Date(s) of Event: ffiy/W-zg /aA <br />Location: ie/Kg A- <br />UTILITIES <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: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: 5Tn k <br />(-FohAc, TiXJc&tOCU <br />/(u/r/< a Time of Event: ~7 <br />AS_______ <br />VcCv.|