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GENERAL EVENT FILE INFORMATION <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />TgJaLAtt^ndance: ^2-^0 <br />-6.Average Age: <br />UTILITIES <br />1.Yes <br />2.es <br />3.es <br />4. <br />25.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />TEMP EVENT APPEHD 16-02 <br />08/01/16 <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 or $139 <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 />San Joaquin Counts <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 />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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <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 />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 /> Date: ^/2>l// <br />Page 1 of 11 <br />Mj\va|C Skiwcr event <br />Date(s) of Event: z Time of Event: <br />Location: 221 VJ (cnttA S v ~ S A u c A <br />Event Coordinator (Name): cant)fl rfUj-dVh?- Telephone: <br />Mailing Address: <br />Number of Food Booths: 2 <br />^2'^7 <br />CA <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: ptij (A <br />Method of disposal of liquid waste for food booths: <br />Approximate attendance at peak time: 250 <br />Event Coordinator: