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GENERAL EVENT FILE INFORMATION <br />Name of Event: Peace Lodi - Peace Walk1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: 15. <br />6. <br />APPLICATION <br />1. <br />2. <br />TEMP EVENT APRPage 1 of 11 <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 />EHD 16-02 <br />8/1/14 <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: Yes <br />Name of sanitary garbage disposal company: Waste Management <br />Method of disposal of liquid waste for food booths: Public sewer <br />o <br />0 <br />Temporary Event Application <br />Application Review Fee of $130 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />KI Yes <br /> Yes <br /> Yes <br /> No <br />K No <br />K No <br />Date(s) of Event: Sunday, June 5, 2016 Time of Event: 2:00pm - 4:00pm <br />Location: Blakely Park, 1050 South Stockton Street, Lodi, CA 95240 <br />Event Coordinator (Name):California Islamic Center - Rehan Anwar/Obaid Khan <br />Telephone: (209) 663-9560/(209) 200-3314 <br />Mailing Address: PO Box 2777, Lodi, CA 95241 <br />Number of Food Booths: _1 <br />Approximate attendance at peak time: 3:00pm - 4:00pm Total Attendance: 200 - 500 Average Age: 25 <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />$130 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 ($195 per hour) <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 />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 ,, <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd '^^02 <br />Ct/—\