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S A N JO A Qu IN Environmental Health Department <br /> Cou1� iy _ <br /> Greatness grows here. n` p <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 <br /> 1. Name of Event: Fouwni oF- JULy FARCrMX-E 'Y'a AoAST <br /> 2. Date(s) of Event: 4 lo 19 Time of Event: 1,00 t,.m - l l 00 AM <br /> 3. Location: 11 l W, rUq+1Sq_ P.o^D U) 1 <br /> 4. Event Coordinator(Name): A LAw fiLee"rA►,4 Telephone: (U% 744- !03+4 <br /> Mailing Address: p.Q. eg< -7lvl L4-p CA 95241 <br /> 5. Number of Food Booths: f <br /> 6. Approximate attendance at peak time: A Cjo Total Attendance: 3000 Average Age: ZS <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ®Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: P�Yes ❑ No <br /> 3. Are janitorial facilities available: ❑Yes ❑ No <br /> 4. Number of toilets provided: Ia <br /> 5. Name of sanitary garbage disposal company:CEwmo. Vt u� VjAuTE Number of dumpsters: 2 <br /> 6. Method of disposal of liquid waste for food booths: U Qo\D \0A ,-i@ W%LL ZE Gnc"cleD <br /> 1N A QoQ7pJ3Lk 1"k1_EZ jb"o 'Dt5P06%S.D <br /> APPLICATION o(& Pm SAV- YMAL.10 R-�q���e�rn�►-►T� <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 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 /> Event Coordinator: Date: J° 1 / <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />