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S A N -J O A Q U IN Environmental Health Department <br /> COUNTY <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 IN ORMATION <br /> 1. Name of Event: G' <br /> 2. Date(s)of Event: — Time of Event: <br /> Q <br /> 3. Location: d <br /> 4. Event Coordinator P(Nam. elephone: ( ��fo '`o� ���[� <br /> Mailing Address: L7M� <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age: C�' <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes YNo <br /> 2. Is electricity supplied and available for each food vendor ❑Yes 2 No <br /> 3. Are janitorial facilities available: ❑Yes EfNo <br /> 4. Number of toilets provided: o <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <br /> APPLICATION <br /> 1. 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> EHD 1"2 Page 1 of 11 07/3/17 TEMP EVENT APP <br />