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"° <br /> �°"'"`�- SANJOAQUIN Environmental Healt�� ent <br /> F'<�� COUNTY---- ftlo <br /> `c9P' Greatness grows here. JUL ?? 2o19 <br /> ENVIRpN <br /> AL P <br /> TEMPORARY EVENT APPLICATION pERMMseR is sLTH <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 /> GENERAL EVENT FILE INFORMATIO (� _� <br /> 1. Name of Event: �,t a ►" <br /> 2. Date(s) of Event: Awo I I <br /> f ime o vent: <br /> W <br /> 3. Location: � i i , y <br /> 4. Event Coordinator(Name): A �r-s� Telephone: ��'3k, <br /> Mailing Address: L - - J <br /> 5. Number of Food Booths: 5 <br /> 6. Approximate attendance at peak time: SOLIDTotal Attendance: 5 0_L::0 Average Age: <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:} Yes ❑ No <br /> 4. Number of toilets provided: ao <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <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 /> understand that as a temporary event coordinator, I am responsible for meeting California State <br /> standards and the Environmental a It artm t policies and procedures. <br /> Event Coordinator: Date: <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3/17 <br />