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Environmental Health Department <br />i Name of Event <br />10/08^0232 <br />3. <br />510-953-88744. <br />5.2 <br />^06.Approximate attendance at peak time:Average Age:Total Attendance: <br />2. <br />3.Io <br />4. <br />nA5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />Date(s) of Event <br />Location:_____ <br />Event Coordinator (Name):. <br />Mailing Address: ______ <br />Number of Food Booths: <br />a) <br />b) <br />c) <br />d) <br />e) <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />of the Food Vendor s Applications no later than two weeks prior to event <br />SAN JOAQUIN <br />COUN1v <br />0res No <br /> Yes QNo^ <br /> Yes <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />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 />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: Number of dumpsters: <br />Method of disposal of liquid waste for food booths: Q. fK <br />fay <br />Time of Event:, iowam^pm <br />Central Park, Mountain House. CA 95391 <br />San Joaquin Kannada Sangha Telephone: ( ) <br />512 St Jorge Ave, Mountain House. CA 95391 <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 />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. <br />Date <br />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />Annual Carnival Datf <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EH016-02 Pagel of 11 TEMP EVENTAPP <br />W19T19