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Environmental Health Department <br />Lo(^\ <br />Average Age: <br />( ca I IaJo^-/c <br />APPLICATION <br />1. <br />2. <br />5. <br />6. <br /> No <br /> No <br /> No <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />^bYes <br />I0-Yes <br />JZ^bYes <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <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: *2 I <br />Name of sanitary garbage disposal company: ( CA I Number of dumpsters: <br />Method of disposal of liquid waste for food booths: picK-c/p srtvicc- <br />Name of Event: Ci'nco Q? Vino <br />Date(s) of Event: tVICfU <5 , <br />Location: Bow/ic/ <br />Event Coordinator (Name):. Mo <br />Mailing Address: Lj. ^2?—! <br />Number of Food Booths:I <br />Approximate attendance at peak time: <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 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 ($228 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: C#!-^ ■ lY <br />KAc>or\ <br />SAIWOAQUIN <br />------COUNTY------ <br />Greatness grows here. <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 />Time of Event:. bp*' -------------------- <br />: W- Hvv^ CA ^52^ <br />__Telephone: (/il-Ci ~ _____ <br />CA ^2^ <br />^7 Total Attendance: <br />■ >'• CA