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No. 0563 P. 2 <br />GENERAL EVENT FILE INFORMATION <br />5. <br />Average Age: Total Attendance: 6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />1. <br />2. <br />3. <br />4. <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 />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 />Io <br /> No KI/A <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 /><-4 /ijpJ Y - <br />Received Time Apr. 13. 2016 12:16PM No. 0693 <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 /> Yes No <br /> Yes Qrt'Ji <br /> Yes <br /> per sTircMf <br />SIGNATURE SPORTS GROUP <br />OAN UUAUUIN CUUIN I It <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-623KtW'£^l « tZM <br />Telephone; (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org^jj^ i <br />Apr.1 3.20 1 6 3:18PM <br />bW <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: NJ/fA - dumber of dumpsters: <br />Method of disposal of liquid waste for food booths: <br />Name of Event: d Sup-CTTVVVkjUr ^SClVVMp ________ <br />Date(s) of Event: 5 / / ({g Time of Eve nt: 10 AfVA TH <br />Location: Fbool (YA&xx 4L y 6 v-J I SV. , C'JA “A L?_____ <br />Event Coordinator (Name): kT^sYirui 'S" Telephone: (T>t) IST.o-TZPT <br />Mailing Address: tSoCb S IVuvW St. SuuLc HCiS f I\JC- <br />Number of Food Booths: _J <br />Approximate attendance at peak time: <br />TEMPORARY EVENT APPLICATION en™rSSc“lth <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