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Name of Event: <br />0? 0 0 AIM - OS' BD pM2. <br />3. <br />4. <br />5. <br />30 ISO6.■ZoTotal Attendance:Average Age: <br />S'Yes <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator::e: <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: <br />Method of disposal of liquid waste for food booths: <br />IM Yes <br /> Yes <br /> No <br /> No <br /> No <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />SAN JOAQUIN <br />------COUNTY------- <br />Grectnesa grows hare. <br />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <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 ($228 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 />Environmental Healt^^^rtment <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department witmafi <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Pl Ck-i n a <br />Date(s) of Event: , 2^01________-rime of Evenf: <br />Location: 3000 Cury Pd CA <br />Event Coordinator (Name): farpido Telephone: ( ZoM U <br />Mailing Address: 3DOO Iftd SYvcX-VO' LA ‘Ad-IC <br />Number of Food Booths:. <br />Approximate attendance at peak time: <br />1868 E. Hazelton Avenue | Stockton, Califomiav952D5^/T 2Q9/468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/11? 02 Pa9e 1 Of 11 TEMP EVENT APP