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SAN JOAQUIN COUNTY <br /> N: ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c,Fo¢a 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 i, <br /> 1. Name of Event: � � I D ii <br /> 2. Date(s) of Event: 12m <br /> // II// ,n, � i I Time of Event: imn — <br /> 3. Location: 1 ctc ( �' � o ye� 'V► <br /> 4. Event Coordinator(Name):_c_1 l LL �, xV Te/lephone: -7 y <br /> Mailing Address: ao <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: 51 Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: XYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: XYes ❑ No <br /> 3. Are janitorial facilities available: Yes ❑ No <br /> 4. Number of toilets provided: At� ±WvL <br /> 5. Name of sanitary garbage disposal company: 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) 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 /> 2. 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 /> 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 Depart t policies and procedures. <br /> Event Coordinator. Date. W <br /> EHD 16-02 Page tof 11 TEMP EVENT APP <br /> 7/14/15 <br />