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D <br />TEMPORARY EVENT APPLICATION <br />Name of Event: 1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: Total Attendance: Approximate attendance at peak time: 6. <br />UTILITIES <br />1.es <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />I\ <br />IV Date: Event Coordinator: <br />TEMP EVENT APPPage 1 of 11 <br />Yes <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. 1 I <br />EHD 16-02 <br />7/14/15 <br />I understand that as a <br />standards and the <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />mpone <br />nental <br />eye <br />al h <br />do^rdinator, I am responsible for^mee|ing California State <br />ieP' ' <br /> No <br /> No <br /> 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 />UoPi <br />Event Coordinator (Name):_J <br />Mailing Address: <br />Number of Food Booths: <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 ($195.00 per hour) <br />tA'T - <br />le forr-meeti <br />ient policies and procedures./ yl <br />2016 - <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 />life <br />_ ~ Z-A ^VTime of Event: <br />TAp^CZ^-L^TelephoneT^^M - - i — <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/ehdc5 Q <br />VIHour <br />Date(s) of Event: V <br />Location: L-OV) <br />GENERAL EVENT FILE INFORMATION