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4P44!Ify SAN .10AQUIN COUNT <br />�� •.o\. <br />y ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <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 <br />1. Name of Event <br />2. Date(s) of Event: �-0 A r\_� l3Q Z-CfOTime of Event: cptom — a2pl!) <br />3. Location: Z ocy�, C- a -Q CIE -2-1+D <br />4. Event Coordinator (Name):q- ,✓�frl?-i ��e�p V,i 0V) Telephone: (2-13,33- ��4I <br />Mailing Address: j7 s- 5. {--r.�,� S-ue. d_a�Lr CaX• <br />5. Number of Food Booths: <br />'20 <br />6. Approximate attendance at peak time: 50� Total Attendance: Average Age: <br />UTILITIES <br />1. Is potable water supplied and available for each food vendor: Ves ❑ No <br />2. Is electricity supplied and available for each food vendor:19/yes ❑ No <br />3. Are janitorial facilities available: E'Yes ❑ No <br />4. Number of toilets provided: 2-E5 I r <br />5. Name of sanitary garbage disposal company: 4a5� 1"►a.nr 2cme,4 Number of dumpsters: <br />6. Method of disposal of liquid waste for food booths:\i&"A� &vL 1p 61rcc -Jn <br />APPLICATION <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 />2. 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 at one and one half times ($208.50 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}. q <br />Event Coordinator: Date: _1 12' 1 I <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />08/01/16 <br />