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J <br />2. <br />3. <br />4. <br />JU J <br />I5. <br />?Zob Average Age:Total Attendance: Approximate attendance at peak time:6. <br />UTILITIES <br />1. <br />2 <br />3. <br />4. <br />5. <br />6 <br />APPLICATION <br />1. <br />2 <br />Event Coordinator,Date: <br />TEMP EVENT APPPage 1 of 11 <br />7 . <br />- i <br />EHD 16-02 <br />7/14/15 <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: <br />Method of disposal of liquid waste for food booths: A <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 /> No <br /> No <br /> No <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 />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> Number of dumpsters: <br />Irly <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 />• aL <br /> Yes <br />Yes <br />J^] Yes <br />IC ncjy <br />•5 la CC <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 />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 halftimes ($208.50 per hour) <br />■ 2>— <br />GENERAL EVENT FILE INFORMATION <br /> <br />Date(s) of Event: tlvillb Time of Event: / <br />Location: J <br />Event Coordinator (Name):~QacJ -'UjA/'Telephone: (2^7) <br />Mailing Address: "Tqi.jaju Ai L.IO- 33/^/_____ <br />Number of Food Booths: