Laserfiche WebLink
Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />ISlL5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br />Approximate attendance at peak time: <br />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 />GENERAL EVENT FILE INFORMATION <br />1. <br />TEMPORARY EVENT APPLICATION J <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 />UTILITIES <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: TU D'T Number of dumpsters: <br />Method of disposal of liquid waste for food booths: VJt) rP/YY) V /C <br />Date(s) of Event: <br />Location: <br />Event Coordinator (Name) <br />Mailing Address: j <br />Number of Food Booths: <br />INFORMATION z / • /7 <br />LI h erti/'-YJ <br />ame): /Telephone: <br />'irlfd '.hvr ■fan /b <br />... _: T otal Attendance:Average Age: b <br />nt>^^CtCjb <br />SANJOAQUIN <br />COUNTY <br />Greatness grows here <br /> Yes V! No <br /> Yes 0 No <br />K] Yes No <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 $152 / <br />c) Temporary Food VendorsjApplications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List