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SAN JOAQUIN COUNTY rn--)�� <br />N .—crr K LIQ <br />ENVIRONMENTAL HEALTH DEPARTMENT e"D <br />_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 D <br />P/ Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh4JL 2 l 2017 <br />4C1FOpc?, <br />ENVIRONMENTAL H <br />PERMIrrSERv►CLrH <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 />GENERAL EVENT FILE INFORMATION a� <br />1. Name of Event: Aiuvc, a -h, c�-� <br />2. Date(s) of Event: L I 1 -7 _ / Time of Event: <br />3. Location: t { JT t d( <br />4. Event Coordinator (Name):\, l C )I, it -Telephone: d014 &3 <br />Mailing Address: L:- L��T �� z C� L` 1 �— j (�( !� ({ <br />5. Number of Food Booths: <br />6. Approximate attendance at peak time:.� ��� Total Attendance: Average Age:. � L( <br />UTILITIES <br />1. Is potable water supplied and available for each food vendor: Q'Yes ❑ No <br />2. Is electricity supplied and available for each food vendor: ❑ Yes ❑ No <br />3. Are janitorial facilities available: l .Yes ❑ No <br />4. Number of toilets provided: �` h % <br />5. Name of sanitary garbage disposal company: �/ (/ �, 1". Qyll% wwdumber of dumpsters: <br />6. Method of disposal of liquid waste for food booths: (,c.'Cl.J& Lil.i��l�':� <br />APPLICATION <br />1. 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 />2. 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 />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 />Event Coordinator.IJDate: 7" <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />7/14/15 <br />