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GENERAL EVENT FILE INFORMATION <br />1. <br />8:00 Am -10:00 P.m2. <br />3. <br />4. <br />5. <br />100-150100 50Approximate attendance at peak time:Average Age:6.Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3. <br />64. <br />1Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: <br />TEMP EVENT APPPage 1 of 11EHD 16-02 <br />7/28/10 <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 />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 />E Yes <br />E Yes <br /> Yes <br /> No <br /> No <br />0 No <br />a) <br />b) <br />c) <br />d) <br />e) <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 />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $125 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $125 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 ($183 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 />Allied Waste <br />Septic <br />Name of Event: La0 Buddhist Temple Religious Events <br />Date(s) of Event: April, June, July & October 2017 Time of Event:. <br />Location: 7443 S. Newcastle Road Stockton, California 95215 <br />Event Coordinator (Name): SakhOH Telephone: (209 423-4256 <br />Mailing Address: Same aS above <br />4 <br />Number of Food Booths: ___________________________________________________________ <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 />'S^l^KsCe. MarCh 22’ 2Q1?