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1.Name of Event: <br />2. <br />3.i- <br />4.A <br />5. <br />6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />Page 1 of 11 <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 />EHD 16-02 <br />7/14/15 <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />[Tf'Yes <br />H^Yes <br />E'Ves <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 />} am responsible for meeting California State <br />jcies and procedures. <br />TEMP EVENT APP <br />GENERAL EVENT FILE INFORMATION <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $130 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 ($195.00 per hour) <br />th <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:^ z <br />Name of sanitary garbage disposal company: / / ^ >1 <br />Method of disposal of liquid waste for food booths: S -S <br />I understand that as a temporary event coordinator, <br />standards and the Environmefital Health-Department pc <br />San Joaquin Coun .. <br />Environmental Health Department 2^6 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehac^p^^LHfi^- <br /><48 <br />Date(s) of Event: 3 Py H Time of Event:. ?w -ft-) Pfii <br />Locati on: <br />Event Coordinator (Name):. Gift I (2a rYf d&i Telephone; (^’^ 23^-^ 0^0 <br />Mailing Address: ; <br />Number of Food Booths: / <br />Approximate attendance at peak time: /£>c> Total Attendance: Average Age: <br /> No <br /> No <br />- No ' k. 2 <br />lOA^^ ) h+M- <br />___Number or dumpsters: 3