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--� SAN JOAQUIN COUNTY I0 m <br /> Q.��.,i " y ENVIRONMENTAL HEALTH DEPARTMENT <br /> lam: <br /> ' 1868 East Hazelton Avenue, Stockton, CA 95205-623, 1 2 ZO15 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s ov. r / hh�� <br /> iVVI�1�t�19K HEALTH <br /> PERMIT/SERVICES <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 /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: Stockmarket <br /> 2. Date(s)of Event: 12/5/15 Time of Event: 1 Oam-4pm <br /> 3. Location: 630 E. Weber Ave. Stockton, CA 95202 <br /> 4. Event Coordinator(Name): Amy Sieffert Telephone: (20g 610-0482 <br /> Mailing Address: 235 N. San Joaquin Street, Stockton, CA 95202 <br /> 5. Number of Food Booths: 4 <br /> 6. Approximate attendance at peak time: 250 Total Attendance: 450 Average Age: 32 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Q Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Ves ❑ No <br /> 3. Are janitorial facilities available: &?Yes ❑ No <br /> 4. Number of toilets provided: 4 <br /> 5. Name of sanitary garbage disposal company: Downtown Stockton Alliance(sPc"sumber of dumpsters: 2 <br /> 6. Method of disposal of liquid waste for food booths: WastAo be removed by vendors. <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 ealth Department policies and procedures. <br /> Event Coordinator: Date: <br /> EHD 16-02 Pagel of 11 TEMP EVENT APP <br /> 7/14/15 <br />