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P--(1A-Ity Event Coordinator: <br />c, SANIOAQUIN <br />COU NTY--- <br />Greatness q rows <br />Environmental Health Department <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: el of- (+AV alf 61---A--hi)v-N Al* (AG( t <br />Date(s) of Event: ,AUkk-f f Time of Event: itU 0 6, vy-1 <br />Location: tio6Ck ("Ace- I I 01 k.) • Tbr 1,ecti CA I 5.2-1-1 <br />Event Coordinator (Name): 61/11 1 \ Ott-0 114g.)-( Telephone: OM 12.-61 (-1 • s-.1/) <br />Mailing Address: I-2:5-- S. tML,t4111 c Sireivt- C&i Of- gs-24 <br />Number of Food Booths: <br />Approximate attendance at peak time: "750° Total Attendance: e>61,14\i,2 Average Age: d, t. <br />UTILITIES <br />Is potable water supplied and available for each food vendor 12 'Yes II No <br />Is electricity supplied and available for each food vendor: 1114es E] No <br />Are janitorial facilities available: Yes El No <br />Number of toilets provided: 30 7_ - ya ker.] <br />- Name of sanitary garbage disposal company: \ljtA Number of dumpsters: <br />Method of disposal of liquid waste for food booths: 1KO_1-' ((I.J rv( p (Jou, <br />APPLICATION <br /> <br />1. Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $152 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br /> <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 />Date: (i9 Ca 2-1-1 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-34201 F 209 464-0138 wvvw.sjgov.orgiehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <br />PR 0562-35