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GENERAL EVENT FILE INFORMATION <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />6.Approximate attendance at peak time: Total Attendance: <br />UTILITIES <br /> Yes1. <br />2. <br /> No3. <br />4. <br />/Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />TEMP P/CNT 4PPcun 1«.no Pona 1 1 1 <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 />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 <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />San Joaquin Cou, , r <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />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 />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 /> Date: / ~ <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 />^>60 <br />Date(s) of Event: Time of Event:_ £■'00 ^7) — '^2'] <br />Location:/D&O ^-^53cy <br />Event Coordinator (Name): /Qrl/. Zl/A/ /97z>2ZZ?/\/Telephone: ~«a?c3/<3 <br />Mailing Address: Z^/Az<t^Z?Z-Z/ <br />Number of Food Booths: <br />Average Age: <br /> No /\/o <br /> Yes No <br />□"Yes <br />of toilets provided:.^ U <br />Name of sanitary garbage disposal company: d . <br />Method of disposal of liquid waste for food booths: /v//9^