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received <br />SEP 1 6 2016 <br />GENERAL EVENT FILE INFORMATION <br />F <• s ^4 I <br />1. <br />*'2. <br />3. <br />4. <br />5. <br />/r6>C>Average Age: y Total Attendance:6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATION <br />1. <br />2. <br />This application is to be later than two weeks prior to the <br />/6Date:Event Coordinator: <br />TEMP EVENT APRPage 1 of 11EHD 16-02 <br />08/01/16 <br /> No <br /> No <br /> No <br />[3 Yes <br />S'Yes <br />SfYes <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 />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:s_______ <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <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 $139 <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 />• $139 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 ($208.50 per hour) <br />- -i completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no L.2— ~ <br />event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environ ealth/Departmerif policies and procedures. <br />— ? <br />Time of Event:A- A ' <br />A -v tod ■ ( >1 ‘tixyo <br />Telephone: J 2 / <br />ici). Cfl <br />S / r\ /JAy r S <br />r <-/ / --2 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 ENVIRONMENTAL HFAi tp <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e|^RMfT/SERV)c|^‘-IH <br />Name of Event: 1 r\ iVS f A / <br />Date(s) of Event: r ~7 / ~ 2 . 2 c i L <br />Location: '; E < «- i 7, -. i s,.) j ~___ <br />Event Coordinator (Name): Q j v. Io 6>/4 <br />Mailing Address: 2 Uo '-> pie r Aruj <br />Number of Food Booths: <br />Approximate attendance at peak time: