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GENERAL EVENT FILE INFORMATION <br />Name of Event: 1. <br />7H2. <br />3. <br />4. <br />5.cAge:Total Attendance:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />35. <br />6. <br />APPLICATION <br />1. <br />— co <br />2. <br />Date: Event Coordinator: <br />TEMP EVENT APR <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 />EHD 16-02 <br />7/14/15 <br />Date(s) of Event: <br />Location: <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />v a) Temporary Event Application <br />t 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 /> No <br /> No <br /> No <br />San Joaquin Couni <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />LkTYes <br />Q^Tes <br />ETVes <br />^^0^9 <br />b <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmer^al Health Department policies and procedures. <br />P'ao^ 1 of 11 <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 />TEMPORARY EVENT APPLICATION <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 />/32W <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: Civ'3 - T <br />Name of sanitary garbage disposal company: <br />Telephone: (2?^) <br />SduJc frv]' LA <br />Time of Event: <br />(ll AC <br />Event Coordinator (Name): <br />Mailing Address: A 0 f3>y^ <br />Number of Food Booths: <br />Approximate attendance at peak time: <br /> C/A/d- Number of dumpsters: <br />Method of disposal of liquid waste for food booths: 1