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GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />UTILITIES <br />1. <br />L <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />Page 1 of 9 TEMP EVENT APP <br />3. <br />4. <br />5. <br />6. <br />7. <br />2. <br />3. <br />4. <br />5. <br />6. <br />EHD-16-02-002 <br />8/7/2003 <br />Temporary Event Application <br />Application Review Fee $93.00 hour with a 1 hour minimum <br />Temporary Food Facility food vendors permit application <br />Site Plan <br />Yes <br />[3 Yes <br /> No <br /> No <br /> No <br />San Joaquin County <br />Environmental Health Department <br />304 E Weber Avenue 3rd Floor Stockton, • CA 95202-2708 <br />(209) 468-3420 * Fax: (209) 464-0138 • Web: www.co.san-joaquin.ca.us/ehd <br />Is potable water supplied and available for each food vendor: ® Yes <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: 2- <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />Submit the following to Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />If Festival/Event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $93.00 per hour, weekdays 8:00 am to 5:00 pm. <br />• After regular business hours, weekday, weekends and holidays, the inspection is charged at <br />the hourly rate, calculated at one and a half times. <br />TEMPORARY EVENT APPLICATION <br />(To be completed and signed by Event Coordinator, then returned to Environmental Health Department with all <br />Food Vendor’s Checklists no later than two weeks prior to event) <br />Name of Event: <br />Date of Event:. 7, S' <br />Type of Event: 1695 1698 <br />Location: <br />Event Coordinator (Name): Fr. /-Ux-f ( <br />Mailing Address: IpZ-o bJ, <br />Number of Food Booths: / <br />7 <br />Approximate attendance at peak time: Zoo <br />Number of Food Handlers:. <br />Total Attendance: Soo <br />Duration of Event: Fr'ida.'-f - <br />.A*** <br />This application is to be completed and signed by the Event Coordinator, then returned to Environmental Health <br />Department with all food Vendor’s Checklists no later than two weeks prior to event. <br />I understand that as a temporary event organizer, I am responsible for meeting State standards as <br />described in the Department of Environment^Health policies and procedures. <br />Fe.bt'uo-^ V, 5^ Time of Event: S-10 <br />“‘Please see Notice to All Temporary Event Organizers’ <br />2-o LJ. Lx _ <br />________Telephone: 77- ^>3/3 <br />_________ <br />IO LJ Profit XI Non-Profit <br />Average Age: (pO <br />Ad <br />Served. <br />-p-fa6' <br />Number of dumpsters: <br />iw:fe|