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1. <br />2. <br />3. <br />4. <br />5. <br />Average Age: Approximate attendance at peak time: \QO£>Total Attendance: 6. <br />1. <br />2. <br />3. <br />4. <br />(2 / / /5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <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 />Environmental Health Department <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />07/3/17 <br />i I <0 -vn ■ <br /> Yes No <br /> Yes t3^No <br />Yes No <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 />UTILITIES <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: *-[ <br />Name of sanitary garbage disposal company: (?, /jX Number of dumpsters: M <br />Method of disposal of liquid waste for food booths: Pndy V encUA L <o-3 care o-F <br />SANJOAOulN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY EVENT 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 />jgj-s)Time of Event: 5'n.vn <br />Ltavs Ot7______SL-tzry h. Ix/yx_________ <br />___Telephone: (^^>) 4? ^7 - ZXjXO 8^* <br />QCe SgiOO <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: S-£z>c-U.4trA ftzrr. tn KT <br />Date(s) of Event: year <br />Location: ^3,3'^ UnnLinc, <br />Event Coordinator (Name): Vzi llorpc?) <br />Mailing Address: ’^7^7 s7~, *-1 <br />Number of Food Booths: