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Environmental Health ent <br />Name of Event: <br />2. <br />3. <br />Telephone: ) '32.1 ~1-/ Z74. <br />5. <br />30Average Age:Approximate attendance at peak time: 6. <br />Yes1. <br />2. <br />3. <br />4. <br />/Number of dumpsters: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 $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />© <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pagel of 11 TEMP EVENT APR <br />07/3/17 <br />SAN JOAQUIN <br />—COUNTY------ <br />■ g r<sws ft ere. <br />MYes <br />HJ'Yes <br />AM <br />- c i -*- ^Date(s) of Event: _ <br />Location: On <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths: <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 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 ($228 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 />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 />GENERAL EVENT FILE INFORMATION <br />1. <br />_Time of Event: <br />Total Attendance: <br />UTILITIES \ <br />Is potable water supplied and available for each food vendor: [El <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: / ip< <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: A1’ <br />5 <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 />*7/3 o/' ~ /G> // /1 7 <br /><7. An//1 <br />< V ■ to Au MSv* <br /><7 O Z- m- /- 4 lAu