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FA (2)0^43 (I <br />1. <br />2. <br />3. <br />4. <br />5.?1±Average Age:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4.1Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />TEMP EVENT APREHD 16-02 <br />08/01/16 <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 />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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <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 /> No <br /> No <br />® No <br />Yes <br />Yes <br /> Yes <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 />Event Coordinator?0^ \ Date: CQ ' <br />Page 1 of 11 <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 />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 Q*. <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />Approximate attendance at peak time: k^CT^Total Attendance: < <br />Event Coordinator (Name):_______ <br />Mailing Address: \k.> r J 9t / <br />Number of Food Booths: \ Zl)_______ <br />? O _____________Time of Event: <br />1 <br />\\ Telephone: (^0^? ~ <br />_________ <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />Date(s) of Event: & _____________Time of EventJ <br />Location: