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I <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />Lp6. <br />7. <br />UTILITIES <br />1. <br />2. <br />3. <br />4.45.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />returned to Environmental Health <br />as <br />II 2^ WDate: <br />Page 1 of 9 11 IMP EVENTEHD 16-02 WEB <br />8/9/07 <br />San Joaquin County <br />Environmental Health Department <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fox: (209) 464-0138 Web: vvww.sjgov.org/chcl <br />Temporary Event Application <br />Application Review Fee $98.00 per hour with a 1 hour minimum <br />Temporary Food Facility food vendors permit application <br />Site Plan <br />Vi, - <br />- <br />Submit the following to Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />CUS <br />I understand that as a temporary event organizer, I am responsible for meeting State standards <br />described in the Department of Environmental Health policies and procedures. , <br />Event Coordinator:A (1 <br />TEMPORARY EVENT APPLICATION <br />(To be completed and signed by Event Coordinator, then returned to Environmental Health Department with all <br />Food Vendor's Checklists no later than two weeks prior to event) <br />If Festival/Event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $98.00 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 a half times. <br />This application is to be completed and signed by the Event Coordinator, then <br />Department with all food Vendor's Checklists no later than two weeks prior to event. <br />Name of Event: <br />Date of Event: \ m \ \^~ <br />Type of Event: 1695 1698 ***l <br />Location: ________________"11Q <br />L <br />l ] No <br />fy^Yes No <br />tj&Yes No <br />Is potable water supplied and available for each food vendor: &Yes <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided:Q <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />|\i(Yr gm-cfy S-Ux Co p <br />Time of Event: p ix Duration of Event: <br />Please see Notice to All Temporary Event Organizers**** <br />M <br />Event Coordinator (Name):Telephone: ( 2^) <br />Mailing Address:_________________ <br />Number of Food Booths:(5- Number of Food Handlers: jp Profit Non-Profit <br />Approximate attendance at peak time: S 0 0 Total Attendance:Average Age: