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<br />SAN JOAQUIN Environmental Health Department <br />l^3TKQ|Ot> <br />2 <br />3 <br />4 <br />5 <br />6 Average Age Total Attendance <br />1 <br />2 <br />3 <br />4 <br />OTgr^ciJ €r}V(^j Number of dumpsters5 <br />6 <br />APPLICATION <br />1 <br />2 <br />Event Coordinator: <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 St 52 <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 />1868 E Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464 0138 I www siqov oro/ehd <br />O&VsW2 Pane lol 11 TEMP EVENT APP <br />GENERAL EVENT FILE INFORMATION <br />1 <br />Dale I 17 I <br />-TLS? \ <br />__n.t. .3^ < <br />UTILITIES <br />Is potable watei supplied and available for each food vendor <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available <br />Number of toilets provided Sd <br />Name of sanitary garbage disposal company. {/Ju s FC f <br />Method of disposal of liquid waste for food booths ^i^POjc cQ CaeiiS-r^z-^-/' <br />/l-fri r'/ O <br />E/j Yes No <br />j^fves O No <br />O'Yes No <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time <br />• SI 52 per hour (weekdays 8 00 am to 5 00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at a <br />minimum three-hour overtime rate of $684.00 <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 />Name of Event <br />Dale(s) of Event S-T <br />Location HfrUS H ,<4>it-ucvy <br />Event Coordinator (Name) \ Cca c, fy <br />Mailing Address ) 7 iA» (z N' <br />Number of Food Booths I <br />Approximate attendance al peak time ICVO <br />2O2Z <br />C V I IxA PrdJc'C I I C>J J _ <br />____Time of Event I ‘D O p <br />CI <rt tf rd t -5 C/4- 7_______ <br />Telephone <7X1 <br />.. ____________