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4. <br />5. <br />6. <br />UTILITIES <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator:Date: <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 />1. <br />2. <br />3. <br />4. <br />1. <br />2. <br />3. <br /> No <br /> No <br /> No <br />AUG 3 1 2017 <br />ENVIRONMENTAL HEALTH <br />PERMITfSERVICES <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 />0 San Joaquin Coun <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/elTi <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 />cVei Date: <br />Average Age. <br />1 <br />Is potable water supplied and available for each food vendor: Yes <br />Is electricity supplied and available for each food vendor Yes <br />Are janitorial facilities available: Yes <br />Number of toilets provided: <br />Name of sanitary garbage disposal comoany~\ UKOAv Numt <br />Method of disposal of liquid waste for food boothsOv\ v\ n^Y\9, K) <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />'° $4-30.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 ($195.00 per hour) <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 $439 \ <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: £a\\ <br />Date(s) of Event: Time of Event?/5 S >• . <br />Location: \V£> Vf), fiptAoVx ___________________________ <br />Event Coordinator (Name): Telephone^O^ (r> VV-\ \~~IQ <br />Mailing Address: <br />Number of Food Booths: A X______ <br />Approximate attendance at peak time: ^-50 Total Attendances O Q) G