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APR 1 0 201? <br />GENERAL EVENT FILE INFORMATION <br />Name of Event:1. <br />U* 3>o2. <br />3. <br />4. <br />5. <br />VX)Total Attendance: "(On Average Age: $£>'' 60Approximate attendance at peak time:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />ITDate: <br />Page 1 of 11 TEMP EVENT APPEHD 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 />Envimnmentai Health Department with all Food Vemfor's Applications no later than two weeks prior to the <br />event <br />San Joaquin County RECEIVED <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, GA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgcNVQR^HfcNTAL HEALTH <br />PERMIT/SERVICES <br />ivr^t CofLW - CZ/fy^tNumber of dumpsters: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the EriVironmen^l Health Department policies and procedures. <br />Event Coordinator:/^ <br />o ff_____ <br />____Time of Event:6 - n <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 />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 />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(2s‘AA^^'V-A-^X’ <br />Name of sanitary garbage disposal company <br />Method of disposal of liquid waste for food booths: <br />¥ <br />Date(s) of Event: <br />Location: Co iY\fA UA| t* <br />Event Coordinator (Name): g, C. t <br />Mailing Address: it*** <br />Number of Food Booths: <br />(^.Yes No <br />[z?Yes ONo <br />Yes No <br />—• i * T> p <br />Telephone: Pjjtpl I <br />qf,37<>_________