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SAN JOAQUIN COUNTY <br /> a A ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <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 /> GENERAL EVENT FILE INFORMATION <br /> f <br /> FR t 1. Name of Event: /1 r 4- V 61 F FT-7S7- <br /> 2. Date(s)of Event: J ON 1F Q 1 ,_01_7 Time of Event: 10/1 M _1-Pl <br /> 3. Location: C:7i OCR'Y 00 77,E J E r <br /> 4. Event Coordinator(Name): Telephone: (?616h <br /> L <br /> Mailing Address: i u o f • t t d J z_E-Z--1-0 N A V • SM Ck_--T-0N0 CA ,72 05 <br /> 5. Number of Food Booths: `��1 / <br /> 6. Approximate attendance at peak time: 26y Total Attendance: Average Age: f <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes E o <br /> 2. Is electricity supplied and available for each food vendor: [IYes j[�` o <br /> 3. Are janitorial facilities available: _ El Yes ®No <br /> 4. Number of toilets provided: A10&1� <br /> 5. Name of sanitary garbage disposal company: N/A Number of dumpsters: '�14 <br /> 6. Method of disposal of liquid waste for food booths: /V <br /> APPLICATION <br /> 1. 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$139 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List <br /> 2. 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 /> 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: Date: 1;5 <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />