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SAN JOAQUIN COUNT* <br /> y. ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �1FORd Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <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: <br /> 2. Date(s) of Event: t-1 lS- L u� 1'1 1? I( 4 ime of Event: <br /> 3. Location: 3� Q O A-A� St-7ppX , W�`l C'ak&- ._7Q_L� �O' 5�crw <br /> 4. Event Coordinator(Name)[�()J5tVCAC �ti W�I�G"�1?',V\�Telephone: (ZcJ <br /> Mailing Address: 23S-2�, 2OLC�t-(2tL l� Gr' t?/V� 0t <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: Z(96V Average Age: '7 Q <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [:1 Yes E]-�o <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes �o <br /> 3. Are janitorial facilities available: ❑ Yes EF-No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal companvvo,3+k- �'1/lU'Lytd�l�' � Cirolber of dumpsters: C�il.1i <br /> 6. Method of disposal of liquid waste for food booths:1-c7o<-Q/1A - S <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$139 <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 /> • $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 /> 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 Environme31 Health partment policies and procedures. <br /> 1 01 Event Coordinator: �M J �I t Date: <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01 116 <br />