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Environmental Health ment <br />Name of Event: <br />2. <br />3. <br />4. <br />5./zxr6.Approximate attendance at peak time:Average Age: <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <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 />’IB) <br /> No <br /> No <br /> No <br />0\es <br /> Yes <br />H^Yes <br />---------------- <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pagel of 11 TEMP EVENT APR <br />06/19/19 <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: <br />Method of disposal of liquid waste for food booths: Sn 1 <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 a <br />minimum three-hour overtime rate of $684.00 <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 />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />Date(s) of Event: __ <br />Location: j / r : <br />Event Coordinator (Name): <br />Mailing Address: I 9-0 <br />Number of Food Booths: <br />Time of Event: ” ' <br />_ ' ; I20 ; 'pi <br />6- Telephone: (2^7) ^>^7 ~~ 5^/ <br />to Per lAJij ft Ils___________ <br />SAN JOAQUIN <br />-----COUNTY------- <br />Greatness grows here. <br />1 Compi e X <br />Cui <br />i io pi - <br />n Sp/VLS <br />'Total Attendance: <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with <br />of the Food Vendor's Applications no later than two weeks prior to event <br />JlJL 0 <br />____—x .. .:xi_