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SAN JOAQUIN <br />v <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 />Name of Event: CRI.11(' '41 ck.v <br /> <br />Date(s) of Event: c2--)Lyt. <br /> <br />Time of Event: tc <br /> <br />Location: 2.5 ivl '-.)-tY t" 1'a A <br />Event Coordinator (Name): t n k'f; e Telephone: (4Iq k.;72 lcI ci <br />Mailing Address: S. Cfm b.1r'41 .ALiñtGfl 1-1C, LJL qcjl <br />Number of Food Booths: <br />Approximate attendance at peak time: Total Attendance: ,,7;C: C Average Age: .3C.' <br />UTILITIES <br />Is potable water supplied and available for each food vendor: 0 Yes 0 No <br />Is electricity supplied and available for each food vendor: E Yes E No <br />Are janitorial facilities available: E Yes 0 No <br />Number of toilets provided: <br />Name of sanitary garbage disposal company:A,=,,f Vc.ittev Rpk v,LcNumber of dumpsters: <br />Method of disposal of liquid waste for food booths: 16 h fi <br />APPLICATION <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 $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />2. If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />$162 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 $729.00 <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: <br />:— <br /> :.; 1 - , F <br />EHD 16-02 <br /> <br />Page 1 of 11 TEMP EVENT APP <br />nAi7q/7071