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SNVh <br /> <br />201? <br />1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: 6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinal <br />Page 1 of 11 <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 />EHD 1M2 <br />08/01/16 <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 /> No <br /> No <br /> No <br />£] Yes <br />S Yes <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 />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 />.'ikof faxL <br />San Joaquin County <br />Environmental Health Department . 1 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 Z ‘ <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehfi^^^^^ <br />Is potable water supplied and available for each food vendor Yes <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 comoanyS^^ M Number of dumpsters: / <br />Method of disposal of liquid waste for food booths: case­ <br />general EVENT FILE INFORMATION <br />Name of Event <br />Date(s) of Event:WkS <br />Location: [(fl <br />Event Coordinator (Name): < ________ <br />Mailing Address: z7 .<Z-_5»~ / /^CrV/l^v <br />Number of Food Booths: ( <br />Approximate attendance at peak time: Total Attendance: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Envir^np^ntal Health Department policies and procedures. / <br /> [io n <br />TEMP EVENT APR <br />h Time of Event: S~4-^ <br />P/Jrlr (Vi./ <br />' Telephone: (%/) ? 7-^ <br />Qp ____________ <br />iHlff