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TEMPORARY EVENT APPLICATION <br />GENERALEVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />UTILITIES <br />1. <br />2. <br />3.es <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />TEMP EVENT APREHD 16-02 <br />08/01/16 <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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br /> Yes <br />[TJ'Yes <br />__W__ <br />Average Age: <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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <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 />Event Coordinator: Date: <br />AiylAih^n ULfy? <br />Total Attendance: 500 <br />Name of Event: A MdioejiS Em Pining w'/Ui 'thz- <br />Date(s) of Event: Q<5 / ! 3> / 1 ___________Time of Event: ('JOropT') ~ ! i ' <br />Locationz.St^Z7/?'//)/? <br />I jf • i 1 i Al »r r a— 13—" t r. i ✓n <br />Event Coordinator (Name):_ <br />Mailing Ad dress: ) <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />San Joaquin Count <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 ^(C <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehc^p^ <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department witnalP <br />of the Food Vendor’s Applications no later than two weeks prior to 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: lo.vu , <br />Number of toilets provided: ^Gjidfirol Toilods m div/C' <br />Name of sanitary garbage disposal company: Stocd'fo/'J (J-d]Number of dumpsters: Q <br />Method of disposal of liquid waste for food booths: 7);,5^/2 5 <br />, M Telephone. (^< 57Z) -1-/20