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D <br />GENERAL EVENT FILE INFORMATION <br />HoI OOP Average Age: Total Attendance: <br />UTILITIES <br />TAf fl Number of dumpsters: <br />1. <br />2. <br />later than two weeks prior to the <br />Date: Event Coordinator: <br />TEMP EVENT APRPage 1 of 11 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br /> No <br /> No <br /> No <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />EHD 16-02 <br />Q/4 14 A <br />Yes <br />Yes <br /> Yes <br />\ I <br />Name of Event: <br />Date(s) of Event: <br />Location: j H * <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: <br />MW <br />APPLICATION <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <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 per hour) <br />This application is to be completed and signed by the Event Coordinator, then returned tojhe. <br />Environmental Health Department with all Food Vendor’s Applications no I---- ------- -------------------------------- <br />event. <br />1^1 I 1 Time of Event. ^~1 W ~~ <br />IAA ftouJWW <br />Fg7~g Telephone: ^01) - 0^7/ <br />T-o- Cf\rr>p( <br />Qk)E <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh^ <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with <br />of the Food Vendor’s Applications no later than two weeks prior to e/ent <br />(y J / San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <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:I Q_. <br />Name of sanitary garbage disposal company:----- <br />Method of disposal of liquid waste for food booths: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the EmArerrmental artment policies and proceduies.