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'a <br />GENERAL EVENT FILE INFORMATION <br />1.Name of Event:( (A <br />2. <br />3. <br />4. <br />5. <br />Average Age: l/V" 3 ITotal Attendance: Approximate attendance ait peak time: 6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time:2. <br />Date: Event Coordinator: <br />Page 1 of 11EHD 16-02 <br />08/01/16 <br />0 Yes <br />0 Yes <br />0Yes <br /> No <br /> No <br /> No <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 />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Tern porary Event Application <br />b) Application Review Fee of <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />• 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 />2.2-^' <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 />V t-^Telephone: (Z^>) ( <br />ix/0 Vcv SV <0^1^ ^5 7 _______________ <br />L/txlld y 'AExA.lveUv_________ <br />___________Time of Event: (a-v <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 />Date(s) of Event: ~ 7- 7 ~ I <br />Location: <br />Event Coordinator (Name).: <br />Mailing Address: \ ^1 & IS <br />Number of Food Booths:~ <br />San Joaquin County <br />Environmental Health Department^^^/s <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 Qrp <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web.-www.sjgov.org/eTid Z 1 2017 <br />Is potable water suppfed and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial fadtees available: <br />Number of toitete provided. A ~ V <br />Name of sanitary garbage disposal company: Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />TEMP EVENT APP