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Environmental Health Department <br />5^2. <br />3. <br />) 'lot- ^jf4. <br />5. <br />^>00 3C6>6.Total Attendance: <br />2. <br />3. <br />4. <br />Wi 15. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />:CSS <br /> No <br /> No <br />| returned to the <br />weeks prior to the <br />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />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 />SAN JOAQUIN <br />-----COUNTY— <br />Greatness gron's here. <br />| ^CO^Time of Event: <br />Yes No <br />S Yes <br />Sf-Yes <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $162 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 $729.00 <br />This application is to be completed and signed by the Event Coordinator, then <br />Environmental Health Department with all Food Vendor’s Applications no later than <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I www sjqov ora/ehd <br />S Pa9e 10,11 ■ tempev^entapp <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 of toilets provided:\(\ i \\ <br />Name of sanitary garbage disposal company: uOW\ - ^Number of dumpsters: , <br />Method of disposal of liquid waste for food booths: fC-' <br />Name of Event: ________j .0^ <br />Date(s) of Event: <br />Location: <br />Event Coordinator (Name):_ fid V SittfV*^Telephone: ( <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time:Average Age: