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oAau1N. <br /> .. �� SAN JOAQUIN COUNT <br /> N ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C4G%F'O•[ta`P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <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 /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: 'Lf_Ic <br /> 2. Date(s) of Event: — Time of Event: l "'� fzlYV1 <br /> 3. Location: -y"_r to "� <br /> 4. Event Coordinator(Name): �t10ecif 0u 1nA4,,MeIephone: <br /> Mailing Address: I �. ` � W , (P_r <br /> ` <br /> 5. Number of Food Booths: 1 <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [7/Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: E9 es ❑ No <br /> 3. Are janitorial facilities available: AA[�Yes ❑ No <br /> : <br /> 4. Number of toilets provided ` <br /> 1 <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: ` ' <br /> APPLICATION <br /> 1. 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 /> 2. 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 /> 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 He Department policies and procedures. i �+ <br /> Event Coordinator: L Date: I C� <br /> —T <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 08/01/16 <br />