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Environmental Health Department <br />JOO Total Attendance: 0 <br />1. <br />2. <br />Date:Event Coordinator: <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Name of Event: . <br />Date(s) of Evenfe <br />Location: ( <br />Event Coordinator (Name): <br />Mailing Address: i , <br />Number of Food Booths: • <br />Approximate attendance at peak time: <br />SAN JOAOUIN <br />------COUN"V------- <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <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 />APPLICATION <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 />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) the <br />n^thentwo^s^toj^ <br />f^erstand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <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:ck—— <br />Name of sanitary garbage disposal company: j <br />Method of disposal of liquid waste for food booths: <br />1868 E. Hazelton Avenue | Stockton, California95205 | T 209 468-34201 F 209464-0138 | www.sjcehd.c^n <br />EHD1«)2 Pagel of 11 <br />07/3/17 <br />TEMPORARY EVENT APPLICATION <br />rvwrtNBVwrrn^rg^ <br /> <br /> <br />Age: <br /> Yes OfNo <br /> Yes EhNo <br /> Yes No <br />(ylhl of dumpsters: <br />: f 0^71! O o f