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4 <br />Environmental Health Department <br />(^-<91.Cj <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: ^0 \:^> Average Age: '2. - (^aO6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <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 />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 /> No <br /> No <br /> No <br />1868 E. Hazelton Avenue | 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 />-------r?g<,A. <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 />SAN JOAQUIN <br />-----COUNTY- <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 />0 Yes <br />EJ/es <br />0Yes <br />GENERAL EVENT FILE INFORMATION . <br />Name of Event: ckcvS sCkj l/ZC_________/ <br />Date(s) of Event: ( 0 ~ IV — -|-O ~~ S Time of Event: 'b* ~ i <br />Location: |G58S y\ v\ 6oc> A\tf0oM&S> <br />Event Coordinator (Name): CLy/Q Telephone: (S25) | <br />Mailing Address: <br />Number of Food Booths:\_________ <br />Approximate attendance at peak time: j Pop <br />Number of toilets provided: "i <br />Name of sanitary garbage disposal company: aAL -frWr <br />Method of disposal of liquid waste for food booths: <br />z , a <br />lC Number of dumpsters: | |S <br />Tf CI ecyw