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Environmental Health Department <br />Total Attendance: Average Age: <br />APPLICATION <br />1.event: <br />2. <br />This then returned to the <br />responsible for meeting California State <br />Event Coordinator <br />5. <br />6. <br />Temporary Event Application <br />Application Review Fee of $152 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br /> No <br /> No <br /> No <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grosvs here. <br />&Yes <br />ykYes <br />■'Q Yes <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www sicehd com <br />176’02 Pag® 1 of 11 TEMP EVENT APP <br />Uli 3/ I / <br />Submit the following to the Environmental Health Department two weeks prior to the <br />a) <br />b) <br />c) <br />d) <br />e) <br />______Number of dumpsters: <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 />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: i / <br />Method of disposal of liquid waste for food booths: <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 />application is to be completed and signed by the Event Coordinator, „,c <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 />Date: |V-2£? <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 />Name of Event: Qf\ Mxif) <br />Date(s) of Event:T>CeiMh-er Time of Event: <br /> <br />Event Coordinator fflameWj^^kl. Telephone: ^() U7l "6^ ( <br />Mailing Address: f Q nOK "I(AV ‘S SZ <5 ____________ <br />Number of Food Booths: ^7__________ <br />Approximate attendance at peak time: SQO