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iGENERAL EVENT FILE INFORMATION <br />1. <br />/Q^ -Time of Event:.2. <br />3. <br />4. <br />5. <br />Average Age: Total Attendance: 6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4.I <br />APPLICATION <br />1. <br />2. <br />9 <br />Event Coordinator: <br />TEMP EVENT APPPage 1 of 11EHD 13-02 <br />7/14/15 <br />5. <br />6. <br />Submit the foilowing to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of $130 <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 W/eb; www.sjgov.org/ehd <br />Telephone: ■ G <br />T)r loo I <br />I <br />'ent coordinator, I am responsible for meeting California State <br />b/Department policies and procedures. <br />'_____________________ _ Date: 'Z-i-A <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />$130 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 atone and one half times ($195.00 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 />MW <br />WiTaai^ <br />I understand that as a temporal <br />standards and the Eiwironmeimal <br /> Yes No <br /> Yes 'p.No <br />Tes No <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: Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />Name of Event: ge, <br />Date(s) of Event: O6!/ <br />Location: <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: I "A- <br />Approximate attendance at peak time: