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Environmental Health Department <br />Name of Event: <br />£-11- H <br />2. <br />3. <br />4. <br />5. <br />90OOi’Average Age:Total Attendance:6. <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 />SAN JOAQUIN <br />“COM NTY- <br /> Yes ££No <br /> Yes 0 No <br /> Yes JJ^No <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />07/3/17 <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental He|^ <br />of the Food Vendor’s Applications no later than two weeks prior to even?* <br />D£C2S20l8 <br /> _____________;______ <br />Time of Event: ~l Op - <br />lo4;, Ca <br />____Telephone:2//J) <br />Ln t Ca ^1^7 0^ <br />l-t-IA 33,AM-13 <br />Date(s) of Event: ’A <<- 13 <br />Location: At <br />Event Coordinator (Name): "RnC-Y- <br />Mailing Address: \ActrY\fYucr <br />Number of Food Booths: <br />Approximate attendance at peak time: <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: <br />Name of sanitary garbage disposal company: Clean SiAc Number of dumpsters: <br />Method of disposal of liquid waste for food booths: <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.