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Environmental Health Department <br />ith all <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />Telephone:J^<^74. <br />/5. <br />6.Approximate attendance at peak time: Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3.Yes <br />MS (4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator Date' <br />7/A <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br /> No <br /> No <br />Name of Event: <br />Date(s) of Event: '3// 7/ <br />Location: / /i . <br />Event Coordinator (Name)? <br />Mailing Address: 7^ C) <br />Number of Food Booths: <br />Yes <br /> Yes <br />Average Age: 3 <br />coordinator, I am .responsible for meeting California State <br />partmeritnolicie&'and procedures^ <br />No <br />SANJOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY EVENT APPLIC/ <br />To be completed and signed by Event Coordinator, then returned to the Environ <br />of the Food Vendor’s Applications no later than two weeks prior <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 e’ <br />standards and the EnvironmentaLHeat <br />-ILE INFORMATION <br />' 1 Z'1-' -y / 7^Time of Event: