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SAN J OAQU I N Environmental Health Department <br /> COUNTY <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 /> GENERAL EVENT FILE INFORMATION r <br /> 1. Name of Event: �` �-► . 11 <br /> 2. Date(s) of Event. �a�iV ',14 Y, Time of Event: V A/I <br /> 3. Location: �l <br /> � <br /> r-1�?r e'f �rG c�,;ri �Ij ;��G��,�' ti;y�jr��d e7 % <br /> 1 <br /> 4. Event Coordinator(Name): Telephone: <br /> Mailing Address: !'fir i �c� �-��� r SLS " /_ 1� ���;, U CA C-7G 1 <br /> 5. Number of Food Booths: ' <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age: i ' <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Q Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes FTI No <br /> 3. Are janitorial facilities available: ❑ Yes M No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: 7 Aet-f,j LJ,, Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <br /> APPLICATION <br /> 1. 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 /> 2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <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 a <br /> minimum three-hour overtime rate of$684.00 <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 /> Event Coordinator: Date: ���i+71ar <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ( F 209 464-0138 1 www sjgov.orglehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENTAPP <br /> 06/19/19 <br />