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SAN 10AQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <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 />Name of Event: <br />2. Date(s) of Event: <br />3. Location <br />Time of Event: (0,a0l <br />l <br />1 .- "n I n _ �r <br />4. Event Coordinator (Name):,104y1 44�-V (A&A- Telephone: -622?1 <br />Mailing Address: >5 � o laal j � (, , sc�40 <br />5. Number of Food Booths: <br />6. Approximate attendance at peak time:&122 Total Attendance:,"Top Average Age: 4 1 + <br />UTILITIES <br />1. Is potable water supplied and available for each food vendor: <br />�1 :es <br />El No <br />2. Is electricity supplied and available for each food vendr: <br />✓o4��s <br />❑ No <br />3. Are janitorial facilities available: <br />es <br />❑ No <br />4. Number of toilets provided: <br />5. Name of sanitary garbage disposal company' i%, <br />/ <br />Number of dumpsters: 3' �Ud� <br />-j <br />6. Method of disposal of liquid waste for food booths: n 04,�uh0'k, <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 />2. 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 the <br />hourly rate, calculated at one and one half times ($228 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: Date: <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br />