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3 0 2017 <br />1. <br />2. <br />3. <br />4. <br />5. <br />0^0 Average Age: ; X.)6.Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />ry e <br />Event Coordinator: Date: <br />Page 1 of 11 TEMP EVENT APP <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 tempgi <br />standards and the Envir <br />EHD 16-02 <br />06/01/16 <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 />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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />coordinator, l/^'m responsible for meeting California State <br />epartment policies and procedures^ <br /> No <br /> No <br /> No <br />San Joaquin Count^ <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />jZI Yes <br />pT| Yes <br />0-Yes <br />Si <br />environmental health <br />reRM1T/SERV1CESrEMp0RARY 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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />Date(s) of Event: ~/l ' ! Time of Event: /C> / G <br />Location: <br />Event Coordinator (Name): O Telephope: <br />Mailing Address: <br />Number of Food Booths: / <br />Approximate attendance at peak time: -300