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dV <br /> A • n. <br /> SAN JOAQUIN COUNTY <br /> `] ENVIRONMENTAL HEALTH DEPARTMENT <br /> 900 Easl Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.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 `�, > <br /> 1. Name of Event: <br /> 2. Date(s)of Event: _ On /I Time of Event: ; AA -� <br /> 3, Location _5 3 0 <br /> 4. Event Coordinator Nam,- `` ' <br /> ( }� � S� �]4�+ 'S?:> �l Telephone: <br /> Mailing Address: v <br /> 5. Number of Food Booths; <br /> 6. Approximate attendance at peak time; Total Attendance: Average Age:0:R3 e <br /> UTILITIES <br /> 1 Is potable water supplied and available for each food vendor: es ❑ No <br /> 2. Is electricity supplied and available for each food vendor: 7es <br /> / ❑ No <br /> 3. Are janitorial facilities availably: ❑ No <br /> 4 Number of toilets provided; n <br /> 5. Name of sanitary garbage disposal company: /V Number 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) Terporary Event Application <br /> b) Application Review Fee of$125 <br /> c) Tem rary 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 /> • $125 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 ($183 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 that as a temporary event coordinator, I am responsible for meeting California State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: Date: <br /> EHD 16-02 Page 1 or 11 <br /> 7/28110 TEMP EVENT APP <br />