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D <br />Dt <br />GENERAL EVENT FILE INFORMATION <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Approximate attendance at peak time: IODO Average Age: 6.Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />A5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator?' Date: <br />TEMP EVENT APPPage 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 temporal <br />standards and the EnvironmentaT <br />EHD 16-02 <br />11/4/14 <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />S Yes <br />13 Yes <br />13 Yes <br /> No <br /> No <br /> No <br />SEP <br />v$nt coordinator, I am responsible for meeting California State <br />Ith Department policies and procedures. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection and travel 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 />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 n <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 3 pnir <br />TEMPORARY EVENT APPLICATION H <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 />few <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:74 <br />Name of sanitary garbage disposal company: / L '05 / E / W//J77IA//Z Number of dumpsters: <br />Method of disposal of liquid waste for food booths: n&/Lv <br />__Time of Event: <br />RNh) Cd _____ <br />__Telephone: <br />_____________________ <br />(Outo LficLy Df- <br />Date(s) of Event: IQ- Tb /C I / .6 <br />Location: f\L 6Nd- • <br />Event Coordinator (Name): /X/CbHRd. UI-Ue/s <br />Mailing Address: t'Q fum <br />Number of Food Booths:/______________________