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f <br />Name of Event. <br />2.iS <br />3.o <br />4 <br />5. <br />Average Aqen ,3 5 76 <br />2. <br />3. <br />4. <br />5. <br />6 <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date 9 3 - < <br />Submit the following to the Environmental Health Department two weeks prjor to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of S152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />SANJOAUuiN <br />-COUNTY- <br />Number of dumpsters: <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />? - / pm <br /> Yes ^^No <br /> Yes No <br /> Yes No <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 />5^3 — )| <br />Pu Q C-C CT?- <br />EnvironmeWal Health Department <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 (S228 per hour) <br />Th/s application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department v/ith 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 />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wv-w.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br />Total Attendance: < <br />Telephone: (q^) <br />C. F5. kYY <br />Date(s) of Event X"Time of Event: <br />Location: Trimly PUl£>v| oC-C oV <br />Event Coordinator (Name): f-Peevy l/r f l<a [ <br />Mailing Address: 5^ <br />Number of Food Booths:'. 5 <br />Approximate attendance at peak time^Tff^Oi