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Environmental Health Department <br />Name of Event:1. <br />2. <br />3. <br />4. <br />5. <br />M5D 40Average Age:Total Attendance:6. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: Event Coordinator: <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 $162 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> Yes <br /> Yes <br /> Yes <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 />SAN JOAQUIN <br />------COUNTY- <br />'cnanvecft Number of dumpsters: A* <br />xn+taChpA-an vendors <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $162 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 $729.00 <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 />UTILITIES <br />1. <br />GENERAL EVENT FILE INFORMATION <br />7 $ ftreu) Uhoc _____ <br />Date(s) of Event: SftfcVVjAOQ -j (YWTJO cff-^C&HTime of Event: <br />Location: kl CA <br />Event Coordinator (Name): Telephone: <br />Mailing Address: 33'31 SuQ ?\/X CZ > (YVAnVf-CA ? CA ^5^71________ <br />Number of Food Booths:M___________ <br />Approximate attendance at peak time: 350 <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wwv^.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />nR/2<v2n?3 <br />h/no <br />H No <br />[/no <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: CfUA Qv <br />Method of disposal of liquid waste for food booths: u