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Environmental Heal epartment <br />Name of Event:1. <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: 5o o Average Age: 6. <br />UTILITIES <br />1. <br />2. <br />3.s4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />- ('Z - tqEvent Coordinator: Date: <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: <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 />'gJ] Yes <br />Ki Yes <br />Kj Yes <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 />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 />SAN JOAQUIN <br />-COUNTY <br />Greatness grows here <br />I \ <br />GENERAL EVENT FILE INFORMATION <br />_pH(li_____ <br />Date(s) of Event: 2*O( *•?Time of Event: ( f 00 /VM <br />Location: <br />Event Coordinator (Name): Telephone: (20?) h\D ' <br />Mailing Address: Ni > 5T, ; 6 A 9 <202. <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />k. i o3 2019 <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departm^bt^M/^y <br />of the Food Vendor’s Applications no later than two weeks prior to event 5