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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />Joo 0x36.Total Attendancl Average Ag <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <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 />Gructnc^ urows here. <br />1868 E. Hazelton Avenue | Stockton, Ca.ifornia 95205 | T 209 468-3420 | F 209 464-0138 | vww.sjcehd.com <br />Page 1 of 11 TEMP EVENT app <br /> No <br /> No <br />Yes No <br />^Yes <br />fel Yes <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• S152 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 (S228 per hour) <br />Name of Event: <br />Date(s) of Event: <br />Location: I IGu <br />Event Coordinator (Name): SCp Q e 'XcAfrS ' <br />Mailing Address: Alp • L& r<5Q (_K 9 S .'S'x, <br />Number of Food Booths:___________________ <br />Approximate attendance at peak time: /0 (KC <br />r“ <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 />Date: <br />: | I io /^ /// ?Time of Event: Ct - U <br />S t KxA-.d [ (j\ 33 ___________ <br />Telephone: ) b '4 Q ? 2.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: ,3 <3 <br />Name of sanitary garbage disposal company: I f <br />Method of disposal of liquid waste for food booths: