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SOo fwetaQQ Age: Total Attendance: <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br /> No <br /> No <br /> No <br />J^Yes <br />pfves <br />JZfYes <br />Environment Health Department <br />SANJOAQUlN <br />------COUNTY------- <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental H^(th Depaftmerit ^all <br />of the Food Vendor’s Applications no later than two weeks prior to even^O^v^ <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />1868 E Hazelton Avenue I Stockton, California 95205 ] T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APR <br />07/3/17 <br />J <br />Date: / CJ fO <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 />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. • o* <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 />GENERAL EVENT FILE INFORMATION <br /> Name of Event: ____PQUj&fc ^06^ 1------------------- <br /> Date(s) of Event: Time of Event: <br /> Location: _____Q& £ D/1 _____("A 7~7/ --------------------------------------------- <br />Event Coordinator (Name): ---------------Telephone: S75^7 <br />Mailing Address: 3 9 H----- <br />Number of Food Booths: <br />Approximate attendance at peak time: <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: Number of dumpsters: <br />Method of disposal of liquid waste for food booths: T)f 6 ’/