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1. <br />2. <br />3. <br />4. <br />5. <br />Average6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator <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 />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 />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 />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 /> No <br />Yes No <br />Yes No <br />Total Attendance: Q Q <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />Date(s) of Event: *4* Time of Event^jU <br />Location:\V?S bd. A*?5'1 <br />Event Coordinator (Name):^X^\ M A 'vPSQ hOQ Lp <br />^/n iz-io p <br />. _______ _______________Telephone: \\~~IC) <br />Mailing Address: A\m\OM <br />Number of Food Booths:\\_______ <br />Approximate attendance at peak time: <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: <br />Name of sanitary garbage disposal company: ^S>^OSA\ Number of dumpsters: <br />Method of disposal of liquid waste for food boothsC\\\d^kc\c\ n <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environm^ntalHealth Department policies and procedures. <br /> Date: <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 4(76 2 R <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 0 <br />Pe^et^lth