Laserfiche WebLink
<br />Environmental Health Department <br />2. <br />3. <br />4. <br />[WL 'idAverage Age:Total Attendance: <br />3. <br />6. <br />APPLICATION <br />1 <br />2. <br />Date: Event Coordinator: <br />5. <br />6. <br />4. <br />5. <br /> No <br /> No <br /> Yes eTno <br />Name of Event: <br />Date(s) of Event: <br />Location: <br />Event Coordinator (Name)j <br />Mailing Address: fiO- &N- <br />Number of Food Booths: I? <br />Approximate attendance at peak time: <br />E^Yes <br />Bl Yes <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: <br />UTILITIES <br />1. <br />2. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />:emporary /event coordi <br />HfUlth Departn^ <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHO 16-02 Pagel of 11 TEMP EVENT APP <br />07/3/17 <br />• teakma ■•Il i waaa« » • ■ H 17 <br />CnAAAmwk| TO <br />)/ X" Time ol Event: <br />u.q-P _____ ______ . <br /> -Telephone: <br />Number of dumpsters: <br />SAN JOAQUIN <br />------COUNTY------- <br />, ( I uf I. IS <p Tifi ll■■| t <br />TEMPORARY EVENT APPLICATION <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 <br />>vO LlQu.)__ <br />Event:_ IOAm - jO p/L^ <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 />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 tp_the <br />event. <br />I understand that as. a temporary /dvent coordinator, I am responsible for meeting California State <br />standards and the E^ir^prr^^Hp/lth Departn/nt policies and procedures.