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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />Total Attendance: | O C' 0 Average Age: 6. <br />p <br />I O4.Z9 f /9 Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date:Event Coordinator: <br />2. <br />3. <br />Date(s) of Event: <br />Location: I 5 <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: <br />Approximate attendance at peak time: <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 />Temporary Event Application <br />Application Review Fee of $152 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br /> No <br /> No <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />phpry <br />_Time of Event: <br />(joo) <br />SfYes □No <br />^Yes <br /> Yes <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <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 />UTILITIES <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APP <br />07/3/17 <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: ________|H 0 T O <br />I Time of Event: (p <br />Telephone: (^5 3 O I <br />P.O. 13^ X (fCfi I <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 event coordinator, I am responsible for meeting California State <br />standards and the Environmental HealthJDepartment policies and procedures. <br />/ ~7 / >7 <br />SAN JOAQUIN <br />COUNTY- <br />Greatness grows here