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Environmental Health Department <br />0 <br />APPLICATION <br />1. <br />2. <br />3 I<35Date:Event Coordinator: <br />5. <br />6. <br />SAN JOAQUIN <br />------COUNTY------ <br />s/ves <br />jVfves <br />Average Age: <br />x— -- ON° <br />d/es 0*No <br /> No <br />Total Attendanck: ^5 <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <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 $172 <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 />• $172 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at a <br />minimum three-hour overtime rate of $774.00 <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 Health Department policies and procedures. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT ARP <br />07/01/7024 <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 />rOCA'C C\Q ? <3 0(3 0 Time of Event: <br />Name of Event: . . j .........-——-— ------------------------------ <br />Date(s) of Event: ? 3 0(3 0 Time of Event: ^5 ~ <br />Location: hJ CmCaOY ? CA _ <br />Event Coordinator (Name): Q CocVtS Telephone: (a<X|) - <br />Mailing Address: Son wsy 3 — <br />Number of Food Booths: B <br />Approximate attendance at peak time: •Sip <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: rOCVClw.C£X <br />A* % TV __ • — <br />Method of disposal of liquid waste for food booths: < , . . „ <br />M 1 Number of dumpsters:!.