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Environmental Health Department <br />Am.. •a <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />6.Total Attendance: <br />Yes <br />2.es <br />3.Yes!34. <br />5. <br />6. <br />APPLICATION <br />1. <br />i <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 />Date(s) of Event: <br />Location: <br /> No <br /> No <br /> 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 />SAN JOAQUIN <br />C O U N T Y <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• S152 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 eyppt coordinator, I am responsible for meeting California State <br />standards and the Environmental Health department policies and procedures. <br />/.I / / ---------- ------------------ <br />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />1. <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 />Numberof toilets provided: <br />Name of sanitary garbage disposal company: umber of dumpsters: <br />Method of disposal of liquid waste for food booths: IvaDlCl <br />-b INrOKMAIIUN / , , <br />/^-/Z Uhlvenriw,^ <br />‘Saj/urclAUj ^p/ Time of Event: SfotiQlVl <br />Event Coordinator (Name): ^Telephone <br />Mailing Address: <br />Number of Food Booths: <?A Srill xJ&'drfV' <br />Approximate attendance at peak time: Z.5tb Total Attendance: Average Age: <br />W// 7 / / <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