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o <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />GENERAL EVENT FILE INFORMATION <br />Total Attendance: Average Age: -SO* <br />UTILITIES <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />Page 1 of 11 TEMP EVENT APPEHD 16-02 <br />11/4/14 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />Name of Event: rx <br />Date(s) of Event: Tu <br />Location: -Opt nr <br />5. <br />6. <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 S.No <br /> Yes KI No <br /> Yes Kl No <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />_______ <br />Event Coordinator (Name): C~S\ IVA, Telephone: (Zc^) C^-ll <br />Mailing Address:iZO Rlfrpri . M ----- ~ ' <br />Number of Food Booths:______ <br />Approximate attendance at peak time: SOp <br />e (4 RlrrYA r 5> r Kp ___________ <br />jS, ZOlLfTime of Event: M 30 — ~1 _ IsO prvy- <br />~ I* <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 />San Joaquin County <br />Environmental Health Department 201s <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 ^l///?0A//wrA.T <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/efi'ffl/Vj/f/^rrf HEALTH <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 />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: C <kA pV R-tPCrT Number of dumpsters: <br />Method of disposal of liquid waste for food booths: rl i SpOX. Ocorx <br />-Q-e ZVu liA IS 2PIUTime of Ei__ <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health^epartment policies and procedures. <br />'<2 o <br />\NMent <br />'ERVic^