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S A N J O A Q U I N Environmental Health Department <br /> �VeoGreatness grows here. Jut <br /> ZQ1:a <br /> 12 <br /> TEMPORARY EVENT APPLICATI6 '0MMFtgTgt <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health Re' all <br /> of the Food Vendor's Applications no later than two weeks prior to event <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: /_S" <br /> 2. Date(s) of Event: i/�f� ���" ��/� �t Time of Event: n/1 <br /> 3. Location: re'3 T lie <br /> 4. Event Coordinator(Name): iC "r— Nam/ Telephone: (� �j L <br /> Mailing Address: 6_30 1fl CCJ�-�>�)D91-,Z I- SletYIe -j 1)4 j <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: 67/' Total Attendance: Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Q`Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes Z;4-f�o <br /> 3. Are janitorial facilities available: L21Yes ❑ No <br /> 4. Number of toilets provided: ' if � ,Ie"' <br /> 5. Name of sanitary garbage disposal company: Ori 0� 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 /> /� / � /6 / <br /> Event Coordinator: -/ - G "� Date: " <br /> 1868 E. Hazelton Avenue I Stockton, California5205 ( T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3117 <br />