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Environmental Health Department <br />Average Age: ITotal Attendance: <br />APPLICATION <br />1. <br />2. <br />5. <br />6. <br />HYes No <br /> Yes Q'No <br /> Yes [vfNo <br />SAN JOAQUIN <br />COUNTY— <br />Greatness grows here. <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Name of Event: OcAohr-Ps.-!- ft /y-j-rs <br />Date(s) of Event: I G> ~ Z~l ' I S’Time of Event: <br />Location: Ui poI / S S 27 e ■ Pro oj . I ,i nden, Hp <br />Event Coordinator (Name):K/drr|/y%- t U ^Telephone: (2^) I ----- <br />Mailing Address: P C? > > CJ^ > 11 --------------------------- <br />Number of Food Booths: „ 3 <br />Approximate attendance at peak time: <br />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 />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 />QVGnt.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 Coordinate <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 ) <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />07/3/17 <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: IO"! ) <br />Name of sanitary garbage disposal company:--------------------------------------- - Number of dumpsters. <br />Method of disposal of liquid waste for food booths: EflJ-P'ACf I Cl . Ki ? <br />Bznd room suok- <br />Date: I 0/ I Z. / / ^ <br />I Dam - -Ipm <br />Oct i y <br />TEMPORARY EVENT APPLICATION^ 20% <br />To be completed and signed by Event Coordinator, then returned to the Environmental HealttfiSepa^tefi^Wi all <br />of the Food Vendor’s Applications no later than two weeks prior to event