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2D\'l <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />UTILITIES <br />Number of dumpsters: <br />APPLICATION <br />1. <br />2. <br />responsible for meeting California State <br />Event Coordinator: Date: <br />Page 1 of 11EHD 16-02 <br />7/14/15 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />5. <br />6. <br />1. <br />2... <br />3. <br />4. <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 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web; www.sjgov.org/ehd <br />TEMP EVENT APP <br />Average Age:. <br />Gli| <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />I understand that as a temporary event coordinator, I am i " ' ' <br />standards and the EnvironmentaLHealtKDepartment policies and procedures. <br />Total Attendance: |f QflO <br />&¥es No <br />T^l Yes No <br />TB'Yes No <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />Date(s) of Event: H <br />Location: <br />Event Coordinator (Name): pfte-S <br />Mailing Address: <br />Number of Food Booths:I <br />Approximate attendance at peak time: <br />Telephone: ^18^^ i / ^11^5 <br />io4 MzuLz/r nssa Co ' <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $130 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 ($195.00 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 />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:15 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: