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<br />SAN JOAQUIN Environmental Health Department <br />i 4,3 7 K (, / 0 0 <br />2 <br />3 <br />4 <br />5 <br />3QTotal Attendance /6 Average Age <br />2 <br />3 es <br />4 <br />5 lumber of dumpsters <br />Method of disposal of liquid waste for food booths J i56 <br />APPLICATION <br />1 <br />2 <br />a <br />the <br />Event Coordinator: Date <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 /> No <br /> No <br /> No <br />event. V <br />I understand that as a temporary event coordinator, I am responsible for meeting California Statl <br />standards and the Environmental Health Department policies and procedures <br />Gd Yes <br />'SA'es <br />N ' 5^ <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time \ <br />• S152 per hour (weekdays 8 00 am to 5 00 pm) \ <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged <br />minimum three-hour overtime rate of 5684.00 <br />This application is to be completed and signed by the Event Coordinator, then returned h <br />Environmental Health Department with all Food Vendor's Applications no later than two weeks prior to^he <br />GENERAL EVENT FILE INF' <br />1. I <br />UTILITIES <br />1 <br />1868 E Hazelton Avenue | Stockton. California 95205 I T 209 468-3420 | F 209 464-0138 I www siaov om/phd '’TEMP Kipp <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor <br />Are janitonal facilities available <br />Number of toilets provided 30 <br />Name of sanitary garbage disposal company. t/Jz? s bC rrw <br />c\ I G) i <br />— ---------- -----------------ORMATION <br />NameofEvent I i u>|'u S <br />Date(s) of Event f 'Z.'Z /'X £-.Time of Event <br />Location l'clfrl|3 (Ut 5 <br />Event Coordinator (Name) <br />Mailing Address ) 7 CXo <br />Number of Food Booths I <br />Approximate attendance at peak time /CVO <br />\2~'OQ <br />j Telephone (?*f) *-? K I 2 <br />\ m •--1 g t» *___________________________ <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 Fhod Vendor’s Applications no later than two weeks prior to event