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Environmental Healt artment <br />/2.’- !(j2. <br />3. <br />4. <br />5. <br />6. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: <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 />□ Yes <br />□ Yes <br />□ No <br />□ No <br />□ No <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />q P3ge 1 of 11 TEMP EVENT APP <br />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />SANJOAUUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY EVENT APPLICATION^ <br />______ <br />,, TeIephone:.Qc’^) 6'^^' " <br />2 Q—... --...w. 2Qi2 <br />To be completed and signed by Event Coordinator, then returned to the Environmental HealthTBiS^aamte^.with all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Date: ~ / 7 <br />Name of Event: ‘/\ <br />Date(s) of Event: <br />Location: ‘Of/kY? <br />Event Coordinator (Name):. <br />F i <br />Mailing AdtJress: <br />Number of Food Booths: <br />Approximate attendance at peak time:3 4 PM Total Attendance:(4/UY-/ Average Age: c i ~/y <br />orQU'Yr, <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: tZpYes <br />Number of toilets provided: / Tjf <br />Name of sanitary garbage disposal company: pCOVIr/crJ Zy umber of dumpsters <br />Method of disposal of liquid waste for food booths:' <br />'Zwa/l Fg^j/vaj_________ <br />Time of Event: } ~ /D <br />T<.- . CALik <br />" - /C> //