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y. A� SAN JOAQUIN COUNT <br /> Ki ENVIRONMENTAL HEALTH DEPARTMENT ° <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ?�iFORN' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd APR D <br /> 08 <br /> "ol/10�V <br /> �16 <br /> TEMPORARY EVENT APPLICATION PERM/TSFF"pTHFq�TH <br /> To be completed and signed by Event Coordinator,then returned to the Environmental Health Department wif lcjlc <br /> of the Food Vendor's Applications no later than two weeks prior to event <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: Stockmarket <br /> 2. Date(s) of Event: 4/23/16 IdI,W19 IWJC) Time of Event: loam-4om <br /> 3. Location: 630 E.Weber Ave. Stockton CA 95202 <br /> 4 Event Coordinator(Name): Amy Sieffert Telephone: (209) 610-0482 <br /> Mailing Address: 235 N.San Joaquin Street,Stockton,CA 95202 <br /> 5. Number of Food Booths: a <br /> 6. Approximate attendance at peak time: 300 Total Attendance: 800+ Average Age: 32 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: CJ Y ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Yes ❑ No <br /> 3. Are janitorial facilities available: [3<es ❑ No <br /> 4. Number of toilets provided: 4 <br /> 5. Name of sanitary garbage disposal company. N/A(taken off site) Number of dumpsters: 0 <br /> 6. Method of disposal of liquid waste for food booths: taken off site <br /> APPLICATION <br /> 1. 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$130 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List <br /> 2. If the event is selected for inspection,the Event Coordinator will be billed for inspection time: <br /> • $130 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 ($195.00 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 lh partment policies and procedures. <br /> Event Coordinator: Date: 418/16 <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 7/14/15 <br />