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Environmental Health Department <br />Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: Average Age: 6. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />10- I - 2-PI1Date:Event Coordinator: < <br />Date(s) of Event: <br />Location: <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 />V pm <br />Event Coordinator (Name):. JKnorina FYunrl <br />Mailing Address: P. O • P>C>X <br />Number of Food Booths: 3 <br />Approximate attendance at peak time: I DO <br />/Q- /<-/- 2.011___________Time of Event: I 0 X//) - ‘I pfp <br />Lndm I4iah MyxJ E. Fred- -4, Lindm , <br />P Telephone: S <br />11LindfBn , 0^ -3^-[io1-/_______ <br />Number of dumpsters: <br />Cc^e3ex\a. 44ch^r)(LHs) <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <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 />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 />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 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: 6 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />t 0Cy^2017 <br />TEMPORARY EVENT APPLICATION'^^ ' <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department yyiMwij <br />of the Food Vendor’s Applications no later than two weeks prior to event s <br />EfYes No <br /> Yes 0 No <br /> Yes EJNo