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2^51(0 <br />D <br />of the Food Vendor's Applications no later than two weeks prior to event <br />1. <br />2. <br />3 <br />4. <br />£4 <br />5. <br />Total Attendance: 6. <br />UTILITIES <br />1. <br />2. <br />3. <br />)P4. <br />Number of dumpsters: <br />APPLICATION <br />1 <br />2. <br />Date:Event Coordinator: <br />Page 1 of 11 <br />5 <br />6 <br />EHD 16-02 <br />7/28/10 <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: <br />Method of disposal of liquid waste for food booths: <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 $125 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />533 4* <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 />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, GA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />E'Yes <br />EjZ/es <br />E^/es <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $125 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 ($183 per hour) <br />fin <br />Name of Event: <br />Date(s) of Event: <br />Location: ______ <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Envirojjm^n^l HealtOepartment policies and procedures. . / <br />- Date: A J H <br />TEMP EVENT APP <br />Average Age: 1D <br />TEMPORARY EVENT APPLICATION H <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />GENERAL EVENT FILE INFORMATION <br /> Pfl/W-to, ’PMpI 5priY¥j , <br />s/aAi me of>Event: S' zz/n ~ <br />Qlf) £ \a)qc^^ <br /> TeIephone: (^) <br />))bA 6- (Y\(lLtr\ ^IPH - h' <br />_____________________