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Paufn' SAN JOAQUIN COUNTY <br /> RECEIVED <br /> rd K ENVIRONMENTAL HEALTH DEPARTMENT <br /> t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 MAR 15 2018 <br /> 7717 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> ENTAL HEALTH <br /> PEWIT/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. Dates)of Event: April 14,June 9,August 11,October 13,2018Time of Event: Wam-4pm <br /> 3. Location: MLK Pfaza,2 E Oak Street, Stockton, CA 95202 <br /> 4. Event Coordinator(Name): Anny Sieffert for Good5tQa Pmductmons Telephone: (209) 610-0482 <br /> Mailing Address: 1974 W Alpine Ave. Stockton,CA 95204 <br /> 5. Number of Food Booths: 8-10 <br /> 6. Approximate attendance at peak time: 300 Total Attendance: 1500 Average Age: 35 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes [9No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes 9No <br /> 3. Are janitorial facilities available: WYes ❑ No <br /> 4. Number of toilets provided: 3 <br /> 5. Name of sanitary garbage disposal company: D—^-nSft�-AM-4,1--11 ;W---W Number of dumpsters 10 cans <br /> 6. Method of disposal of liquid waste for food booths: Vendor to remove 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$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 Caiifomia State <br /> standards and the Environmental Health Department policies and procedures_ <br /> Event Coordinator: Date: 31 I S115( <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08101116 <br />