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Environmental Health Department <br />t <br />Total Attendance: Average Age: <br />Number of dumpsters: <br />APPLICATION <br />1. <br />2. <br />Event Coordinator\1Zl-zrri ly-o -Pem <br />5. <br />6. <br /> No <br /> No <br /> No <br />1. <br />2. <br />3. <br />4. <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 />SANJOAQUIN <br />------COUNTY------ <br />Greotness grows here. <br />[vfYes <br />Q'Ves <br />[R7es <br />. MrpoC-V t/MTA y <br />Event Coordinator (Name):S<5n <br />Mailing Address: % <br />Number of Food Booths:. <br />Approximate attendance at peak time: b( G15C> <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | ^ sjcehd com <br />EHD 16-02 pa9e 1 of 11 TEMP EVENT A <br />07/3/17 <br />Date: <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <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 />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 />GENERAL EVENT FILE INFORMATION <br />Name of Event: IgsCin QDbUr\Vs| --------------------------— <br />Date(s) of Event: ’JurxC- Time of Event: 3 ~ H pVkA------------------------- <br />Location: lUsV ■ MrpoC-V (AfTA.V SbCKXtd/n . C-P._________________ <br />Rntigv^Velephone: (^7) <br />S' forziu- co _________\a ____ <br />Is potable water supplied and available for each food vendor: <br />l.s 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: <br />i” H.. | h <br />II