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Pau N SAN JOAQUIN COUNTY <br /> `NVIRONMENTAL HEALTH DEPAj, i MENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �1FOR�'i Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <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 /> GENERAL EVENT FILE INFORMATION ,/f <br /> 1. Name of Event: e2�A �V <br /> 2. Date(s) of Event: Time of E t: <br /> 3. Location: �)A �! <br /> 4. Event Coordinat r Narpe 3 <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age: <br /> UTILITIES <br /> 9;m2K <br /> 1. Is potable water supplied and available for each food vendor: 2-YesElNo <br /> 2. Is electricity supplied and available for each food vendor. ElYes ®No <br /> 3. Are janitorial facilities available: ❑ Yes No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal compan :'y umber of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths.- <br /> APPLICATION <br /> 1 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$139 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List <br /> 2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br /> • $139 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($208.50 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 /> event. <br /> I understand tha s a temporary event coordinator, I am responsible for meetin California State <br /> standards and th E ironm=HeaDep ment policies and proceduEvent Coordinator: AC <br /> Date: <br /> EHD 16-02 Pa g 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />