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P-220983350Maa 31 16 03:51p Sou"inds <br />Z016 <br />i.Name of Event: <br />2. <br />5, <br />6.Total Attendance: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5.Number of dumpsters: <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />Page 1 of 11 TEMP EVENT APP <br />1:55PM No. 4387Rece i ved Time May. 31. 2016 <br />L-b <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: <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 $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Date(s) of Event: <br />Location: <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 /> Yes Q^Jo <br /> Yes rcpKio <br /> Yes [Q^o <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 />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the E^-vjr^h^ental H^&lth Department policies and procedures. <br />.. " ' 6' <br />San Joaquin County <br />Environmental Health Department 31 <br />1868 East Hazelton Avenue, Stockton, CA 95205-623Zivl/mnWj..r <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.o <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />o SI 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 />GENERAL EVENT FILE INFORMATION <br />Oele^itg/ KeecVer-y________ <br />^-24-7-01C? _Time of Event:_ 4'00- g-oopm <br />Li N«?Lh/ FART- EAST Axlb EM PN AVC TPAG/CA <br />Event Coordinator (Name): Telephone: (^(7)^- A- <br />Mailing Address: <br />Number of Food Booths:I____________ <br />Approximate attendance at peak time: [ QQ