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Environmental Health Department <br />Time of Event 1 'lam-2pm2 <br />3 <br />4 <br />Total Attendance. 715 <br />4. <br />Number of dumpsters <br />APPLICATION <br />1, <br />2 <br />Event Coordinator A Date <br />5. <br />6. <br />5 <br />6. <br />Temporary Event Application <br />Application Review Fee of SI52 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />PI Yes <br />0 Yes <br />0 Yes <br /> No <br /> No <br /> No <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 poor to event <br />SAN JOAQUIN <br />- COUNTY — <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 inS)de hospital <br />Name of sanitary garbage disposal company <br />Method of disposal of liquid waste for food booths <br />aumpsters prov>oed by noscitai <br />OiKXBeci c» ame toe 1 truev s can-misar, <br />1868 E Hazelton Avenue | Stockton Cafifomia 95205 | T 209 468-3420 | F 209 454-0138 | www.sjcehd.corn <br />EHD I*-® Page lot 11 TEMP e/EM AFP <br />Submit the following to the Environmental Health Department two weeks pnor to the event <br />a) <br />b) <br />c) <br />d) <br />e) <br />Name of Event Kaiser Stockton Lunch <br />Datets) of Event ^day, May 24th <br />Location 7373 West Lane, Stockton. Ca. <br />Event Coordinator (Name* SactoMoFo Telephone. (916-400-3978 <br />Mailing Address 1017 L St. #230, Sacramento. Ca. 95814 <br />Number of Food Booths <br />Approximate attendance at peak time 355 <br />If the event is selected for inspection the Event Coordinator will be billed for inspection time: <br />• $152 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 (S228 per hour) <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 />UTILITIES <br />1. <br />2 <br />3 <br />GENERAL EVENT FILE INFORMATION <br />1. <br />Average Age 35