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* <br />/dra Total Attendance: <br />I <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />i <br />Number of dumpsters: <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />SAN JOAQUIN <br />COUNTY <br />I Oro-Gv -V-tULzT- <br />Time of Event: 9-OQ ~ H '-UP <br />Qy ^5310 <br />________________________ Telephone: (*2^) ~ S <br />^4/ zlZ ^!A-4L^_______________^4 <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />1868 E. Hazelton Avenue I Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APR <br />07/3/17 <br />Environmental Health Department <br />10 2013 <br />TEMPORARY EVENT APPLICATION ^LTh <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department Mt^ll <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />UTILITIES <br />Is potable water supplied and available for each food vendor: ^Yes O No <br />Is electricity supplied and available for each food vendor: QYes J^No <br />Are janitorial facilities available: D Yes Q^No <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: ’ 6r\ A +t)n <br />Method of disposal of liquid waste for food booths: — <br />Average Age: 30 <br />Name of Event: Ka OQO C J)cvxrvx\.JL^iA< <br />Date(s) of Event: 4 ( I <br />Location: HaUL| 1^0 ( OC\ , <br />Event Coordinator (Name): 0 vSud <br />Mailing Address: <_____________ <br />Number of Food Booths: <br />Approximate attendance at peak time: <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 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 ($228 per hour) <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 />cvGnt. <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.