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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: 6. <br />2. <br />3. <br />/D4. <br />/Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <br />1868 E. Hazelton A' <br />EHD 16-02 <br />07/3/17 <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />//f <br />tie | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Page 1 of 11 TEMP EVENT APP <br />SAN JOAQUIN <br />------COU NT V-— <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:/ O <br />Name of sanitary garbage disposal company: /’TlACw’ <br />Method of disposal of liquid waste for food booths: <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 />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />TEMPORARY EVENT APPLICATION 3 0 2l>19 <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departm^rt^/fth'.^l! <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />"0 Yes No <br /> Yes l^No <br />jSfYes No <br />_Time of Event: ' / U <br />___________________Telephone: /) V " <br />___ <br />Approximate attendance at peak time: Average Age: <br />Name of Event: /i 116, <br />Date(s) of Event: <C>z3~/ U t~ j <br />Location: y14 Sr <br />Event Coordinator (Name)fafcU mO;</« Ccirn/HU*tii] <br />a i a _i_i / / / / 7Z_T i _ I <br />Mailing Address: _j___ <br />Number of Food Booths: