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DI <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />Total Attendances6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters:5. <br />6. <br />APPLICATION <br />1. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time:2. <br />Date: <br />TEMP EVENT APPEHD 16-02 <br />7/14/15 <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 $, <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> Yes 0No <br /> Yes Q'f'io <br /> Yes [LWo <br />• $13'6 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 ($19&D'6 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 />Date(s) of Event: <br />Location: flfWibn Spcrfc ftuiz I <br />Event Coordinator (Name): <br />Mailing Address: Q'le 14/- 1 <br />Number of Food Booths: I S <br />Approximate attendance at peak time: <br />GENERAL EVENT FILE INFORMATION <br />CM er <br />__Time of Event:_ <br />I2W IO <br />s ,__________Telephone: <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the_Environmental Health Department policies and procedures. <br />Event Coordinator:'^^^ Date: 81^11 <br />Page 1 of 11 <br />San Joaquin Count <br />rlatriA . q 7(llfi Environmental Health Department <br />L 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />\\Eh\$klephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <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 />Average Ag <br />s <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: