Laserfiche WebLink
--------f <br />Environmental Health Department <br />3W * Average Age: <br />APPLICATION <br />1.event: <br />2. <br />responsible for meeting California State <br />Date: <br />5. <br />6. <br />Temporary Event Application <br />Application Review Fee of $179 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />1. <br />2. <br />3. <br />4. <br />I <br />I <br />SAN JOAQUIN <br />------COUNTY------ <br />Submit the following to the Environmental Health Department two weeks prior to the <br />a) <br />b) <br />c) <br />d) <br />e) <br />This i ..................................... _ ‘ - - - _ _ ................................................................................ <br />Environmental Health Department with all Food Vendor's Applications no later than two weeks prior to the <br />Number of Food Booths:TV\/D ( <br />Approximate attendance at peak time: ^00 Total Attendance: O Averaoe Aae- <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <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: 11 <br />Name of sanitary garbage disposal company: 6^j|7mbRr of dumpsters: 2 <br />Method of disposal of liquid waste for food booths: Ul^lUl^l tCVTt^l ClV\c\ (X\Qlpc^ <br />Of local duinnp <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: fiiV^rs IrrAiarn Lodge <br />Date(s) of Event: TimF. of Event: toj th 3 <br />Location: &. U-HlO FfL . , <br />Event Coordinator (Name): IWlDm \lCL\AdCZ. Telephone- (2C^ <br />Mailing Addressp^'1 <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 />Ores No <br />[vTYes No <br />0Y es No <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 />application is to be completed and signed by the Event Coordinator, then returned 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 />Event Coordinator: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.siqov.oro/ehd <br />Pa9e 1 °f 11 TEMP EVENT APP