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GENERAL EVENT FILE INFORMATION <br />Name of Event:1. <br />2. <br />3. <br />4. <br />5. <br />I Average Age: 3 5- WQ2.DO (oOQTotal Attendance:Approximate attendance at peak time:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />54. <br />Gr luTOA)Number of dumpsters: 5. <br />SELF6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />TEMP EVENT APRPage 1 of 11 <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 />EHD 16-02 <br />7/14/15 <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: <br />Name of sanitary garbage disposal company:' <br />Method of disposal of liquid waste for food booths: <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> Yes <br /> Yes <br />®*Yes <br />No <br />B'No <br /> No <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <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 />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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $130 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 ($195.00 per hour) <br />Rtveft Fest____________________________ <br />Date(s) of Event: ‘SATUI^DA-y Time of Event:, aw\ - 3 <br />Location: Jgtcob 'Park - 2 3^>5^3 Sak>ta F~g <br />Event Coordinator (Name):, Kfirrie \AJe-bb Telephone: (Zzz?) <br />Mailing Address: ThIHO S~TA&£T WEHAAW <br />Number of Food Booths: H