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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />6.Total Attendance: Average Age: <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br /> No <br /> No <br /> No <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 />Yes <br />Kf Yes <br />£3. Yes <br />MAy <br />st. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />________________ <br />Telephone: (Z^) 6^^-^ <br />, ca- <15 _______________ <br />UTILITIES <br />1. <br />SAN JOAQUIN <br />------COUNTY- <br />Greatness grows here. <br />f *'v <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 temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />Event Coordinator: Date: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />OT/S/V 02 Pa9e 1 °f 11 TEMP EVENT APP <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:\]\/ l^ <br />Method of disposal of liquid waste for food booths:P| <br />/VT THu <br />Date(s) of Event: MAV l( , ZO (Time of Event: <br />Location: ST, s J , <br />Event Coordinator (Name): <br />Mailing Address: 'C0 7^33^0 <br />Number of Food Booths:I_________ <br />Approximate attendance at peak time: I > <br />TEMPORARY EVENT APPLICATION 201s <br />To be completed and signed by Event Coordinator, then returned to the Environmental Hea^S’^^fment with all <br />of the Food Vendor’s Applications no later than two weeks prior to event ''