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SANAOAQUIN <br />7 L•ii44,64 —COUNTY ---- <br />.116:ear, <br />GrCeltr't94 9rtierS <br />Environmental Health Department <br />TEMPORARY EVENT APPLICATION <br />To be completed arid signed by Event Coordinator. then returned to the Environmental Health Department with all <br />of the Food Vendors Applications no later than two weeks prior to event <br />GENERAL EVENT FILE INFORMATION <br />541r V-anq <br />f/ 2-5 Time of Event: VPril - win <br />Name of Event: <br />Dateisi of Event: <br />Location: 51 N iticr S-f Mod) 5 CA 95a0P <br />Event Coordinator (Name Stiv\CTeleptione. I '70.12 elloS 300 <br />Mailing Address: (33 3 Pike-, r(c_ pesve__ <br />Number oi Food Boottis. 0 <br />6. Approximate attendance at peak time: J (*.) Total Attendance 2.401) Average Age: 30 -'16 fO <br />UTILITIES <br />I. Is potaole water supplied and available for each food vendor: ViYes 0 No <br />Is electncity supplied and available for each food vendor: le Yes 0 No <br />Are janitorial facilities available. 91 Yes 0 No <br />Number of toilets provided SO <br />6. Name of sarutary garbage disposal company: L) YYN Number of durnosters. <br />6. Method of disposal of liquid waste for food booths: E;Ipil u)a-Sk, igl 41 <br />APPLICATION <br />Submit the following to the Environmental Health Department two weeks prior to the event <br />Temporary Event Application <br />Application Review Fee of S1 (2 <br />C) Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />2. It the event is selected for inspection. the Event Coordinator mil be billed for Inspection time: <br />$ /2 per hour iweekdays 6.00 am to 5:00 ()nil <br />After regular business hours (weekday. weekends and holidays) the inspection is charged at a <br />minniurn three-hour overtime rate of $774.1:10 <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 />OSA <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental H9ahDepartmet31.Oss and procedures. <br />Event Coarchnelor Date 3I&A <br /> • <br />1868 E. Ilazetton Avenue I Stockton. California 95206 1 209 468-34201 F 209 46.4-0138 I www.sigov.orgierid <br /> <br />EHD 1642 Pap of 11 TEMP EVENT APe <br />07101,2f24 <br />pR /cm-z-z_s