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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: '2^'^6. <br />2. <br /> Yes3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />'fill <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 />SAN JOAQUIN <br />------COUNTY------ <br />^2------ <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 />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: Vv^eA/v <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <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 coordipator, I am responsible for meeting California State <br />standards and the EnvironmentafHealtb Dedartyfent policies and procedures. <br />itness orow <br />TEMPORARY EVENT APPLICATION ; <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Average Age: M \ A <br />riufa inr vniTiM 11 vn . <br />'•fcm rVw-f <br />Date(s) of Event: 4//3M _____Time of Event: _________ <br />Location: (Y/y IAJ- grYHlP <br />Event Coordinator (Name): V Telephone: (20^ <br />Mailing Address: <br />Number of Food Booths:___________ <br />Approximate attendance at peak time: <br />Number of dumpsters: jJ <br />e; <br />es