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SQN ��QAQ ',r--, nvironmental Health Department <br /> 7 � � 'i COUNT �`�'�i1L"/ LSLJ h <br /> uit( <br /> ' �y,. "•. Greatness grows her'SEP 2 i 2018 gad _ <br /> c C± <br /> ENVfROhMEh�f.^.!.FI-J:�Ti j "J4 u,4, <br /> TEMPORARYfEVENT 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 /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: net <br /> 2. Date(s) of Event: btu lP d Time of Event: �i ' <br /> 3. Location: 1a�a.Kl i ►1 C4h � �1-L00861 01"X I <br /> 4. Event Coordinator(Name): ! 0" Telephone: <br /> Mailing Address: <br /> 5. Number of Food Booths:_V:)( <br /> 6. Approximate attendance at peak time: XD Total Attendance: �� 7 Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes 9 o <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes [2/No <br /> 3. Are janitorial facilities available: ❑ Yes to <br /> 4. Number of toilets provided: 1 -r <br /> 5. Name of sanitary garbage disposal company:0 k, A`VWkk`A- Number of durnpsters: <br /> 6. Method of disposal of liquid waste for food booths: OU U Ytii-t <br /> APPLICATION 5� �• cL�� X 3 <br /> 1. 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 /> 2. 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 /> 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 Coordinator: a Ly — Date: 1 i <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjr-ehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 0713/17 <br />