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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />C5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />Q <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 />//1 <br /> No <br /> No <br /> No <br />imentaj/Health Department policies and procedures. <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 <br />6^ <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 ($228 per hour) <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Enviroi <br />SANJOAOUIN <br />-----COUNTY------ <br />Greatness grows here. <br />, ') Time of Event: <br />Total Attendance: <br />O'Yes | <br />Q'Yes | <br />LS^es | <br />D fc CC3 Number of dumpsters: <br />osal of liquid/waste for food booths?lofaT <br />C <br />‘IS <br />2 9 2017 <br />TEMPORARY EVENT APPLICATIONnv/ROnmenT <br />To be completed and signed by Event Coordinator, then returned to the Environmental Healtff©S0Hi^^j:^ffi$yn4 <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Event Coordinator:___ <br />Telephone: ‘ I7 ^- / -Y R <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />Date(s) of Event: <br />Location: <br />Event Coordinator (Name):. A/ fai-/. , <br />Mailing Address: (jo, rvyriMv <br />Number of Food Booths: X- ■ *4 <br />Approximate attendance at peak time: 'C-V’C Average Age: <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: j <br />Method of disposal of liquid/waste for food booths' <br />/ ■r <br />-xl.L/FOF^x