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Environmental Healt epartment <br />1. <br />2. <br />3.- <br />4. <br />5. <br />4C>0o j-Average Age: 6. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <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 />Event Coordinator (Name): ]/tHlVYL Q-^(dC <br />1 1 f S' : - i ( • vi . <br />Mailing Address: J <br />Number of Food Booths: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Rage 1 of 11 TEMP EVENT ARP <br />07/3/17 <br />__Number of dumpsters: <br />[TpuJ off 9-fc- <br /> Yes QNo <br /> Yes No <br /> Yes O 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 />/ /?// <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />0 <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Departm^Hfarfyjt^fc^llTZy <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Ripsvi Q-f '.Talf IWuMris <br />_______Time of Event: <br />rzu vu- Riva ,^0^1 <br />5 co- 9 -oo pm <br />6A ________ <br />___Telephone: (AC/jj <br />---------------------------- <br />Approximate attendance at peak time: 1 j < Total Attendance: <br />UTILITIES <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 (~) <br />Name of sanitary garbage disposal company: QlTU rvtOy \ <br />J * r- I 1 ’ " I <br />Method of disposal of liquid waste for food booths: j