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GENERAL EVENT FILE INFORMATION <br />UTILITIES <br />APPLICATION <br />1.event: <br />2. <br />Date: <br />Page 1 of 11 TEMP EVENT APP <br />EHD 16-02 <br />08/01/16 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />5. <br />6. <br />I understand that as a tempera <br />standards and the Enviix5pmental <br />Event Coordinator: <br />1. <br />2. <br />3. <br />4. <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: ^>00 Total Attendanc^: <br />; O No <br />® No <br />H No <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 />Submit the following to the Environmental Health Department two weeks prior to the <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 />Is potable water supplied and available for each food vendor: [3 Yes <br />Is electricity supplied and available for each food vendor: Q Yes <br />Are janitorial facilities available: Yes <br />Numberof toilets provided: | A C) A- I Ctjask S/zlIm <br />Name of sanitary garbage disposal company: KtAeira Number of dumpsters: <br />Method of disposal of liquid waste for food booths: f T.'V ! <br />San Joaquin Coun <br />Environmental Health Department 20/6 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 ENV/Ronmf <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/erfaERMlT/s^JJ^LTH <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 />This application is to be completed and signed by the Event Coordinator, then returned to the <br />event”1"161^3 Hea th DePartment w,th al1 Food Vendor’s Applications no later than two weeks prior to the <br />Name of Event: 'tBco <br />Date(s) of Event: Time of Event:_______________________ <br />Location: e cidr Pro ( <75~337___________ <br />Event Coordinator (Name):77>H i nu'S Telephone: (^) ^3^-7 j <br />IS 3 , (Vo HA. Si V <br />/ > ( C Average Age: 5>(Q <br />event-^ coordinator, I am responsible for meeting California State <br />lealth Department policies and procedures. <br />k/ _________ Date: _ ~ / S'" _______