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�OP�tU \ SAN JOAQUIN COUNT. <br /> •CMG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1\ / 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> `Q ,6 ' Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.orq/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. NameofEvent: C�.HIL.DREN'S CFlRN1\1b1 _ SQL-ANT .- _.,P1.UGT10N <br /> 2. Date(s)of Event: 1Q_I acs' Q O 110 Time of Event: 10 A M- a P M <br /> 3. Location: ate 1.0 OAK ST - Loyil CA 5.,;k4O <br /> 4. Event Coordinator(Name): IV f-1 T fl L1 l= Y11 L SZ Telephone: (;tom <br /> Mailing Address: —ann L) Owl. ST. - L..ODI, 0-[) 9 5a40 <br /> 5. Number of Food Booths: 1 <br /> 6. Approximate attendance at peak time: a0-30 Total Attendance: ;Q()O Average Age: c;t 0� <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Z Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: 19 Yes ❑ No <br /> 3. Are janitorial facilities available: X Yes ❑ No <br /> 4. Number of toilets provided: b <br /> 5. Name of sanitary garbage disposal company: LL)&5NE M iNAGEMfeNZNumber of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: J A N yT bRfr11_ S%N1. <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 Health Department policies and procedures. <br /> Event Coordinator: Date: ��1 C�1 <br /> EHD 16-02 age 1 of 11 TEMP EVENT APP <br /> 7/14115 <br />