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GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: 6.Total Attendance: <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <br />>n1868 E. Hazelton Avenue | Stockton, <br />EHD 16-02 <br />06/19/19 <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 />I5205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pagel of 11 TEMP EVENT APP <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 a <br />minimum three-hour overtime rate of $684.00 <br />Th/s 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 Environmerrtst Health Department policies and procedures. <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: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />^Yes Q} No <br /> Yes No <br /> Yes ^No <br />SANJOAOUIN <br />-----COUNTY------ <br />Greatness grows here. <br />.■ [jouw _ <br />^l. (For?.' <br />Environmental Hea^g^jytment <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department witn all <br />of the Food Vendor's Applications no later than two weeks prior to event <br />.ILb INt-UKMA I ION <br />Name of Event: <br />Date(s) of Event: 01^ Time of Event: <br />Location:.itei o____1_____ <br />Event Coordinator (Name): ------- ---------------------------------------- Telephone: ) <br />Mailing Address: <br />Number of Food Booths:{ <br />Approximate attendance at peak time: