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GENERAL EVENT RLE [NFORMATSON <br />1. <br />2. <br />3 <br />4 <br />5. <br />2)0 Average Age: l otal Attendance: Approximate attendance at peak time:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4 <br />105. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />TEMP EVENT APPEHD 16-02 <br />7/14/15 <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 />San Joaquin Counts <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: v/ww.sjgov.org/ehd <br />fr <br />Number of dumpsters: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />Page 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 />^Yes No <br /> No <br /> No <br />f EMFUKARY kVfcN f APhLICAHON <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 />\\Ackv\o <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 />Name of Event: <br />Date(s) of Event: to|5|lfo, - , <br />Location: 55^ S> er \ io A /Xoe <br />Event Coordinator (Name) C <br />Mailing Address: <br />Number of Food Booths: <br />Vt'— V <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: f ine VTAC <br />-Vo LjotxoX-e.. <br />---------------------------------------------------T|l<Jl(o, 3 ‘ Time of Event: ~ I ^<3HQ_______ <br />A ol O _______ <br />___________Telephone: (olC^ 5 -3-^6