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Environmental Health Department <br />Number of dumpsters: <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: <br />03151 <br />5. <br />6. <br />5. <br />6. <br />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />® Yes <br />O Yes <br />S Yes <br /> No <br />No <br />I^No <br />P(2.OS^~iz3 <br />^002^^00 <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to tine Environmental Health Department with all <br />of the Food Vendor s Applications no later than two weeks prior to event <br />SANxJOAOUIN <br />■------COUNTY------- <br />Greatness qro<vj here. <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 toilete provided: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />Reivfiuc t. . .. <br />VbftXfc, utyj&mo OS <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <br />Total Attendance: <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />4/zt- (SAr) ___________ _______ <br />MftlWA PfilVE, CA ISLANDS TECH <br />Name of Event: <br />Date(s) of Event <br />Location: tn5 <br />Event Coordinator (Name):. l&lLL- HAA-LQu)Telephone: (4jQ 44 <br /> Mailing Address: to q^8j south ca <br />Number of Food Booths: 20 1 <br />Approximate attendance at peak time: 4oa Average Age: <br />if the event is selected for inspection, the Event Coordinator wifi be billed for inspection time; <br />• $162 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 S729.Q0 <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with ail 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 /> Date: 3^6 Mt 7 <br />1868 E. Hazelton Avenue | Stockton, California 95205 J T 209 468-3420 | F 209 464-0138 I www.sigov.orq/ehd <br />Page 1 on 1 TEMP AFP06/29^023 <br />-4, <br />/^Acx-r VcezA; Assoc^i <br />Time of Event: Q-l PK