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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />Total Attendance:time: 6. <br />2. <br />3.es <br />4.-fe ■hrtd')5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: 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 $156 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />JX] Yes <br />^XYes <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <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 grows here. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $156 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 $702.00 <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 />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1.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: d--------------- <br />Name of sanitary garbage disposal company: IV Number of dumpsters: g <br />Method of disposal of liquid waste for food bootjrs: <br />Name of Event: ocnnoi imy <br />Date(s) of Ev9l % q l/< io|(<». felaA <br />Location: Hey Sdwpj ? ■ n*| <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: I / y <br />Approximate attendance at tii <br />tile iiNry/rviyiMi imin . <br />W€ sV H la h Schm I La vW Qt&iiilS'_______________ <br />Time of Event: 3.0)? H- I GOOFF) <br />TF<7a| Gy 9^3?^ <br />Telephone: $ Q <br />14 t Ca 9. < 3 [fa____ <br />\ Average Age: ~ <br /> No <br /> No <br /> No