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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <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: � �, �,�� R r-tkog <br />2. Date(s) of Event: P&AQ �Z.0 t9� Time of Event: <br />3. Location: �2s g , � (�, c 5 6 t r"-Jk i.—Oat, CA <br />4. Event Coordinator (Name): Telephone: (LO% 333 — fo8't <br />Mailing Address: 12.S' S. 4tt+dai 2 Si C,�Pr, cks-Z-{L�) <br />5. Number of Food Booths: 1 <br />6. Approximate attendance at peak time: 4y v Total Attendance: Average Age:0 <br />UTILITIES <br />(-4 0) <br />1. Is potable water supplied and available for each food vendor: �es ❑ No <br />2. Is electricity supplied and available for each food vendor: Vs ❑ No <br />3. Are janitorial facilities available: �s ❑ No <br />4. Number of toilets provided: _ 21 <br />5. Name of sanitary garbage disposal company: � grxm zri umber of dumpsters: -2 _W <br />6. Method of disposal of liquid waste for food booths: )A1g,:Ae_ 4Aick cord <br />aq�` bZoor )2.k04Q-gN <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <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 a <br />minimum three-hour overtime rate of $684.00 <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: Date: `3 O (� <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <br />