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1. <br />2. <br />3. <br />4. <br />5. <br />366Total Attendance:6. <br />UTILITIES <br />1. <br />2. <br />es3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coord inatofc. <br />TEMP EVENT APRPage 1 of 11EHD 16-02 <br />08/01/16 <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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />H Yes <br /> Yes <br /> No <br />[ZNo <br /> No <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 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 ($208.50 per hour) <br />Number of dumpsters: / <br />^jt\ .sink; kj-khe/) <br />GENERAL EVENT FILE INFORMATION <br />°Time of Event: / 4^7} <br />_______Telephone: $^) 5 6 <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 />.. a Date: 10-1-19_____ <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: - x <br />Number of toilets provided: /O T~ \L/]Cl^6K ] <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />Name of Event: J <br />Date(s) of Event: /6 " ~ i _____________ <br />Location: Liirkf] Uityh Schoo! 1 <br />Event Coordinator (Name): hCLU 1(4 ■ , - ~ <br />Mailing Address: P-6.6>()X /16V Ljcdokl. 66• ^^6.36" 66^/' <br />Number of Food Booths: <br />Approximate attendance at peak time: Average Age: / <br />San Joaquin County <br />Environmental Health Departmen^t^, <br />1868 East Hazelton Avenue, Stockton, CA 95205-6235^/^^,^ <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www sjgov.org/&m^'/7 <br />ocr,, <br />TEMPORARY EVENT APPLICATION^, J* <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Dep£wc^4?j(Ji all <br />of the Food Vendor’s Applications no later than two weeks prior to event