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SANJOAOUIN Environmental Health Department <br />Name of Event:1. <br />Time of Event: 2. <br />3. <br />4. <br />5. <br />Average Age: Total Attendance:6. <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />-7/Date: <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 />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: <br />Method of disposal of liquid waste for food booths:~TS <br />__Telephone: ^0^) 7 U <br />b(vr> <br /> Yes ^No <br /> Yes No <br /> Yes S' No <br />3 <br />Event Coordinator: ' <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 />UTILITIES <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420, F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <br />, 0? 2021TEMPORARY EVENT APPLICATION^,^ <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health uepfiRSQ^Mj^S.l^y <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />SAN JOAQUIN <br />LT-"....? T -----COUNTY----- <br />Greatness grows here. <br />GENERAL EVENT FILE INFORMATION <br />Po tu-U Vu; S yu cKTO t-* <br />Date(s) of Event: <br />Location: HhS' <br />Event Coordinator (Name):~Vov~A^ \ k > <br />Mailing Address: I 7 2x0 C OLAa-A C .Ly, V? <br />Number of Food Booths: <br />Approximate attendance at peak time: /