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Food Vendor’s Checklists no later than two weeks prior to event) <br />APPLICATION <br />1. <br />2. <br />Event Coordinator^ <br />Page 1 of 9 TEMP EVENT APP <br />6. <br />7. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />EHD-16-02-002 <br />8^/2003 <br /> No <br /> No <br /> No <br />1. <br />2. <br />3. <br />4. <br />5. <br />San Joaquin County <br />Environmental Health Department <br />304 E Weber Avenue 3rd Floor Stockton, ■ CA 95202-2708 <br />(209) 468-3420 • Fax: (209) 464-0138 • f^eb: www.co.san-joaquin.ca.us/ehd <br />'wnber of dumpsters:<3 <br />Submit the following to Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />TEMPORARY EVENT APPLICATION <br />(To be completed and signed by Event Coordinator, then relumed to Environmental Health Department with an <br />UTILITIES <br />Is potable water supplied and available for each food vendor Yes <br />Is electricity supplied and available for each food vendor. Yes <br />Are janitorial facilities available: Yes <br />Number of toilets provided: <br />Name of sanitary garbage disposal company. V/cVs <br />Method of disposal of liquid waste for food booths: x <br />GENERAL EVENT FILE INFORMATION <br />L 0V <3 ^ <br />Ail <br />Temporary Event Application <br />Application Review Fee $93.00 hour with a 1 hour minimum <br />Temporary Food Facility food vendors permit application <br />Site Plan <br />If Festival/Event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $93.00 per hour, weekdays 8:00 am to 5:00 pm. <br />• After regular business hours, weekday, weekends and holidays, the inspection is charged at <br />the hourly rate, calculated at one and a half times. <br />This application is to be completed and signed by the Event Coordinator, then returned to Environmental Health <br />Department with all food Vendor’s Checklists no later than two weeks prior to event <br />I understand that as a temporary event organizer, I am responsible for meeting State standards as <br />described in the Department of Environmental Health policies and procedures. <br /> Date: <br />Name of Event: OuP CP Qjl m ( <br />Date of Event: Z/Z^C&STirne of Event: Duration of Event: P/V\--------------------- <br />Type of Event:W 1695 1698 ‘“Please see Notice to All Temporary Event Organizers““ <br />I nration:O era ____________________ <br />Event Coordinator (Name): l\O<^ Telephone: (Q^ 7^/ 7 7------------ <br />Mailing Address: _______________ <br />Number of Food Booths: / Number of Food Handlers: o? O Profit ^Non-Profit <br />Approximate attendance at peak timek^ffOO Total Attendance: z3 O Average Age: -2)-5----------- <br />I <br />i . V