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4. <br />4- <br />Average Age: (9^>Total Attendance: O <br />UTILITIES <br />1. <br />4. <br />L5.Number of dumpsters: <br />APPLICATION <br />1. <br />2. <br />Date: <br />EHD 16-02 TEMP EVENT APP <br />1. <br />2. <br />3. <br />5. <br />6. <br />2. <br />3. <br />^0-Yes <br />t^Yes <br />'Q Yes <br /> No <br /> No <br /> No <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 />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6^^, <br />■IB) <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 />Is potable water supplied and available for each food vendor: <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 company: <br />Method of disposal of liquid waste for food booths: <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 />°5 2017 <br />I b I I | h I I J % V I I W4 X Ilf X XX VX Am XX XX XX . * <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.eM'MENTAi <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: / y Date- /A//-?- <br />Page 1 of 11 <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: mco L)<Z Majo (fa r-f-ui _______ <br />Date(s) of Event: /T]^U Time of Event: ’^7/D —/^/O<77 <br />Location: <br />Event Coordinator (Name): Telephone: <br />Mailing Address: & 333) fg cJ'-to Stodzfon t cA 7S3d~i <br />Number of Food Booths: /'<- <br />Approximate attendance at peak time: <br />SubmitThe following to the Environmental Health Department two weeks prior to the event: <br />Za) Temporary Event Application <br />Zb) Application Review Fee of $139 <br />c) Temporary Food Vendors Applications for each booth <br />zo) Temporary Event Site Plan <br />e) Food Vendor List