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D <br />GENERAL EVENT FILE iNFORMATiON <br />Name of Event: 1. <br />2. <br />3. <br />4. <br />5. <br />L_|bO Average Age: Total Attendance: Approximate attendance at peak time:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />TEMP EVENT APPEHD 16-02 <br />7/14/15 <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the. <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />® Yes <br />H Yes <br />® Yes <br /> No <br /> No <br /> No <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 f <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e <br />nd procedures. <br />MP <br />ELEvent Coordinator^ <br />nvironmentaJ Health Department policies nnd <br />r <br />This application is to be completed and signed by the Byent 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 />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 at one and one half times ($195.00 per hour) <br />u-Co ______ <br />C/\ ^^<-{2.________ <br />Telephone: (i^| '-22.'-1' M’ZtjGS 0*4 <br />A”’ '■—...... <br />Date(s) of Event' __ <br />Location: Mil SV. <br />Event Coordinator (Name): <br />Mailing Aduress: ^\VV\\PCcA <br />Number of Food Booths: \ <br />JUN o 9 20l6 <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health DeparTm^^fiftU/g^ <br />of the Food Vendor's Applications no later than two weeks prior to event <br />umber of dumpsters' <br />Is potable water supplied and available for each food vendor: <br />Is electricity supolied and available for each food vendor: <br />Are janitorial far ides available: <br />Number of toilets provided: M <br />Name of sanitary garbage disposal company:. <br />Method of disposal of liauid waste for food booths: <br />L/ ll / 114 %//(* Time of Event: <br />■" ' ‘ f 1 L____LAl