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Environmental Health Department <br />Average Age: (4C)Total Attendance: 30G <br />APPLICATION <br />1. <br />2. <br />Date: 3 ” 3^Event Coordinatoi <br />5. <br />6. <br /> No <br /> No <br /> No <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www sjcehd com <br />OZ/J/v'02 Pagelofn ' TEMP EVENT APR <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 />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />TEMPORARY EVENT APPLICATION <br />O e completed signed b>Coordinator, then returned to the Environmental Health Department with all <br />or the Food Vendors Applications no later than two weeks prior to event <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 ($228 per hour) <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. ~ -------------- <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />SANJOAQUIN <br />------COUNTY------ <br />Greoiness i]iow$ h&re. <br />Name of Event: <br />Datefs) of Event:^^Fvpn, <br />Location: * MA CA O <br />Event Coordinator (Name): Aon, Telephone-Pf <br /> Mailing Address. KO ISo X, t b <br />Number of Food Booths: <br />Approximate attendance at peak time: ’T^C) <br />Is potable water supplied and available for each food vendor: Yes <br />Is electricity supplied and available for each food vendor: JX^Yes <br />Are janitorial facilities available: yes <br />Number of toilets provided: 3 (I k&Ui'CAp) 6 fevhcvxs) <br />Name of sanitary garbage disposal company: Zhilfan S^llJ Number of dumpsters: J <br />Method of disposal ofliquid waste for food boothsfEXtirW^siM f— <br />^17/ ^/^^meo^ Event: Sp^ fc)