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Environmental Health Department <br />_ Average Age: Total Attendance: '300 <br />APPLICATION <br />1. <br />2. <br />Date: 3 <br />f <br />I’M <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />b) <br />c) <br />d) <br />e) <br />This <br />Environmental Health Department with all Food Vendor's Applications <br />temporary event coordinator, I <br /> No <br />XYes No <br />Yes No <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />Application Review Fee of $152 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />SAN JOAQUIN <br />------COUNTY------- <br />6reoL ■?ess GfQvvs hei't. <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 />. c°m?lete.d a.nd s!9ned. by the Event Coordinator, then returned to the <br />nuont ' -------------------- ' ------------------ - no later than two weeks prior to the <br />ttVuni. <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 />Event Coordi <br />EH8o6?fi o; Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sicehd.com <br />o7/£17 Pagel of 11 TEMP EVENT APR <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: ^SCOlcifx <br /> Date(s) of Event. 6 2j^ & ' o! Event: S <br />Location; 137^7 I CA Event Coordinator fName):J^^^zv\ McAj t AC K Telephone <br /> Mailing Address. I 0 1>)/, (pA ; C/A _____________ <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />TEMPORARY EVENT APPLICATION <br />o e completed atlcI signed b>' Even‘C^dinator, then returned to the Environmental Health Department with all <br />he Food Vendors Applications no later than two weeks prior to event <br />UTILITIES <br />Is potable water supplied and available for each food vendor: Yes <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: 3 I <br />Name of sanitary garbage disposal company: Zhtlfcn Number of dumpsters: J <br />Method of disposal ofliquid waste for food boothsfLlurW/Acl I~h4-e (73 <br />YUy\ {PWcuA ' ’