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SA N )MUM Environmenldl Health Department <br /> COUNTY------ <br /> TEMPORARY EVENT APPLICATION <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health Departme <br /> of the Food Vendor's Applications no later than two weeks prior to event 0,e%T992011, <br /> iEw <br /> ® <br /> r.�'VIppHM <br /> GENERAL EVENT FILE INFORMATION pE� IT>� RiC st. <br /> 1. Name of Event: <br /> 2. Date(s) of Event: �r , Time of Event: <br /> 92 <br /> 3. Location: 1 Ale r,—A �K-_ �- <br /> / �i �. L-2 <br /> 4. Event Coordinator(Name):N1l/��/� �/1/��t�f'�Teleph/one: (�� -S �_c- Ll <br /> Mailing Address: /<� Z<�kze �7z �7® 2�2,v, cl"A �2 s ,Q4� <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: DUB Total Attendance: Average Age: `',ice <br /> UTILITIES <br /> 1. Is potable water supplied.and available for each food vendor: [ 'Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: [ Yes ❑ No <br /> 3. Are janitorial facilities available: Eales ❑ No <br /> 4. Number of toilets provided: l,,Z <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: u few <br /> APPLICATION <br /> 1. 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 /> 2. 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 /> Event Coordinator: / c- �)(/ 2 Date: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3/17 <br />