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Average Age:. 9-6Total Attendance:' OOP <br />UTILITIES <br />rofof sanitary garbage disposal company: <br />1. <br />2. <br />Date: <br />TEMP EVENT APRPage 1 of 11 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />EHD 16-02 <br />11/4/14 <br />Yes No <br />^Yes <br />KI Yes <br />RECEIVED1 <br />juN 0 8 2015 <br />San Joaquin County <br />Environmental Health Department :i Zlj !') <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 ., i <br />Tefephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/6tid - 'PRVICEs'^ <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 />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Healtp Department policies and procedures. / / <br /> Event Coordinator: ------------------- Date: ^//--------------- <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: <br />Date(s) of Event: <br />Location: dlVA\l^ [ <br />Event Coordinator (Name): Vi <br />Mailing Address: j <br />Number of Food Booths: _13 _______ <br />Approximate attendance at peak time: 1^0 O <br />_Time of Event:. q/V.lAA--7p.NA <br />yaiio (c<w <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: Yes No <br />Are janitorial facilities available: K.Yes No . <br />Number of toilets provided: <40 54^^^ <br />Name of sanitary garbage disposal company:(jfl |~Number of dumpsters. <br />Method of disposal of liquid waste for food booths: • A'€lr‘€ <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 and travel 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 to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks pnor to the <br />event.