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1© <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: 1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: 6. <br />UTILITIES <br />1. <br />2. <br />3. <br />IS4. <br />Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />Page 1 of 11 TEMP EVENT APP <br />fl <br />EHD 16-02 <br />7/14/15 <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 />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 /> Yes <br /> Yes <br /> Yes <br />San Joaquin County^^ <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ironmental Health Department policies and procedures. <br /> Date:. <br />itf] No <br />E] No <br />;[fe| NO <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the <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 atone and one half times ($195.00 per hour) <br />j <br />JUft <br />IOUO Ldbl na^-CILUi I nvcuuc, <_>iuvr\iun, <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehj^^AfzVf^^ <br />ENVIRONMENT HEALTH ruPERMIT/SERVICES rhi <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 r <br />Ml 7 2016 <br />lopV) <br />l <br />Telephone: <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: |) 115 L ()( :/ 37^' <br />Date(s) of Event: T1H11 U? <br />Location: (Y\vSfri iA OzLf <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths: <br />Time of Event:___ <br />12-Qi vo. j Rxpcyr <br />Qv/y ii i na.i, a s-i a____ <br />Approximate attendance at peak time: Total Attendance: