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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.crglehd <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: FR U17- 4� VE6 61 E FE1 r <br /> 2. Date(s) of Event: Ml� Y /3, /20/ 7 Time of Event: 2 PM <br /> 3. Location: WIlt —M1 K_T ME/01413 0R I-100D S TO R�- p <br /> 4. Event Coordinator(Name): /A(5 / O 6LE-I /V Telephone: ( 41&8 <br /> Mailing Address: 1U0 1 E• l I�zEL�N A VE, 'S-100--7-ON,C/1 c/5205 <br /> 5. Number of Food Booths: 2 <br /> 6. Approximate attendance at peak time: 200 Total Attendance: Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes [�No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes j`No <br /> 3. Are janitorial facilities available: ❑ Yes Q No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal Company: of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: i//,4 <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 ironmental Health Depa ent policies and procedures.. <br /> Event Coordinator: Date: SIoll In <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />