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1 <br />Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />Average Age: 3qTotal Attendance:3oq>6. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br /> 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 />SAN JOAQUIN cz. <br />AUG 01 2018TEMPORARY EVENT APPLICATION <br />To.be comD[etg^^djSkn|^<jL|by Event Coordinator, then returned to the Environmental Health Department with all <br />E^''pERMIT/SERvS^ Food Vendor's Applications no later than two weeks prior to event <br />Name of Event: y <br />Date(s) of Event: <br />Location: /h i cZg A rux <br />Event Coordinator (Name): <br />Mailing Address: ^5'c?oo <br />Number of Food Booths: <br />Approximate attendance at peak time: 3oo <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 />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />1868 E Hazelton Avenue I 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 />D & y i n <br />, Zoi 8 <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: <00 ni./ Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />a n a id L o 4-a * <br />Rd_____LljcJ > <br />Yes No <br />0 Yes No <br />0 Yes No <br />____________Time of Event: | — ~7 f <br />0*^1 S p /IveLi________________________ <br />____Telephone: *7 - J # I V