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Environmental Health Department <br />7 <br />7_Total Attendance/ ^300 O <br />D <br />APPLICATION <br />1, <br />2. <br />Event Coordinator: Date: <br />1868 E. Hazelton Avem <br />EHD 16-02 <br />07/3/17 <br /> Yes <br /> Yes <br /> Yes <br />5. <br />6. <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 /> No <br /> No <br />EpNo <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: <br />Number of toilets provided:_____________ <br />Name of sanitary garbage disposal company: (Wy jT]4 <br />Method of disposal of liquid waste for food booths: Cocycle, hucfr i, <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />ar Zo&9 -7^/ <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 />| Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Page 1 of 11 TEMP EVENT APP <br />2 Average Agi <br />3 <br />Number of dumpsters: <br />/SvMANJOAQUIN <br />; .Si ------COUNT Y <br />Greatness grows here. <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 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 />event>nmenta Hea th DePartment with al1 Food Vendor’s Applications no later than two weeks prior to the <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 />Name of Event: p i < ,7~7u TA <br />Date(s) of Event: [ j /^7) -f- \ <br />Location: l hr: <br />Event Coordinator (Name): Hr51//H e « <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: T00 <br />__________________________ <br />Time of Event: Api'ZfztJ 5P/W-?m /6am to 9 <br />Telephone: (g^)