Laserfiche WebLink
SEP 2 0 2017 <br />Name of Event: <br />2. <br />3. <br />4. <br />W4 St~ • <br />5. <br />4^SCO6.Approximate attendance at peak time:Average Age: <br />UTILITIES <br />1. <br />2. <br />3.es <br />4. <br />I5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <br />1868 E. Hazelton Avenue |^Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <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 />Date(s) of Event: <br />Location: <br />Environmental Health Department <br />Q'Ves No <br /> Yes No <br /> No <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 />GENERAL EVENT FILE INFORMATION <br />1. <br />SAN JOAQUiN <br />-----COUNTY------ <br />Greatness grows here <br />TEMPORARY EVENT APPLICATION PERMIT/SERVlCES^^n <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 />gwTotal Attendance: <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: I Q <br />Name of sanitary garbage disposal company: MeHACK i"^ ‘ f •,,, <br />Method of disposal of liquid waste for food booths: <br />Diorws Qdsin LODI___________________ <br />.... lo/zq/iT- Time of Event:, <br />____________________________ <br />Event Coordinator (Name):J frShuq Telephone: HW2--3D0 <br />Mailing Address: ___________________________ <br />Number of Food Booths: