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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />Average Age: Total Attendance: 6. <br />2. <br />3. <br />4. <br />Number of dumpsters: 5. <br />6. <br />APPLICATiON <br />1. <br />2. <br />Date:Event Coordinator: - >=■ <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 />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 />SANJOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />Gres No <br />[ZpYes No <br />B'Yes No <br />GENERAL EVENT FILE INFORMATION <br />1. <br />UTILITIES <br />1. <br />'Vo:'; pm <br />• -Sfy <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T,209 468-3420 | F 209 464-0138 | www.sjgowo^rg/ehdpp <br />Name of Event: <br />Date(s) of Event: cm Time of Event:. <br />Location: WMOo CWC huchWiuvn <br />Event Coordinator (Name): Telephone: (T-DQ- Cp'L <br />Mailing Address: 102)5 CA, <br />Number of Food Booths:_ <br />Approximate attendance at peak time: G? p'|Y\ <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 $179 <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 />• $179 per hour (weekdays 8:00 am to 5:00 pm) <br />« After regular business hours (weekday, weekends and holidays) the inspection is charged at a <br />minimum three-hour overtime rate of $805.50 <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 />^ // /