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ENV11 <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: 1. <br />2. <br />3. <br />4. <br />5. <br />2-50 Average Age: Total Attendance:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <br />TEMP EVENT APPPage 1 of 11EHD 16-02 <br />08/01/16 <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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <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 />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 <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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <br />^TAL HEALTH <br />SERVICES <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />— __________ Date: Co \ <br />Date(s) of Event: Co lM-1 Time of Event: • QQ(X Aa. ~~ '2.‘D0pyY\ <br />Location: mCj-LcA. SckooK 68S Mountain ) <br />Event Coordinator (Name): RflAA ■ E> Rztryx N ■Telephone: (A©^ A08- 3^^ ■ 52.9$ <br />Mailing Address: 4b°i N- Ob • MOurfbain - CA-^5391__________ <br />Number of Food Booths: 3 _ <br />Approximate attendance at peak time: 2-5T) <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:L9___________ <br />Name of sanitary garbage disposal company: <br />Method of disposal of liguid waste for food booths: Sfiqk IfreejoTuJb.q <br />J/f Yes No <br /> Yes T3*No <br />JZfYes No