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SANdOAQUIN Environmental Health Department <br /> COUNTY <br /> c r Grect;i,-s< .crows her,. . <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: �j f �-rla l�! C' R T'I G nIV - � MB0�31,✓��/ �� `� <br /> 2. Date(s) of Event: NO yg: 61 1R i.,J W2 S Time of Event: 16 AM -- 6, Fly <br /> 3. Location: I 1 3_ i 5 P91 1y�rE <br /> 4. Event Coordinator(Name):M)k_AK Ah4 4 5WA1 Telephone: (2847 _5 91O - 2_gr.33 <br /> Mailing Address: 3�St Z <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: J � Total Attendance: �,I�b Average Age: C) - 4 <br /> UTILITIES I <br /> 1. Is potable water supplied and available for each food vendor: O'Yes ❑ No <br /> 2. is electricity supplied and available for each food vendor: 0/Yes ❑ No <br /> 3. Are janitorial facilities available: OYes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: -ril <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$179 <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 /> • $179 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$805.50 <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 D artment policies and procedures. <br /> Event Coordinator: Date: _ /d 4- 26Z5_ _ <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 1 6-p2 Page 1 of 11 �� �.,TEMP<EVENT APP <br /> 07/071011202fi `.i <br />