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i 05Z13y0 <br /> SAN : OAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <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: �, M/3p 'Il4c / r EW ESP- <br /> 2. Date(s) of Event: - QZC' - q - Time of Event:�q# <br /> 3. Location: �I J3 rJ �CQ,CCe Al / _� 1 C 652-cry <br /> 4. Event Coordinator (Name): Pi¢GARP-Al 9AA1 Telephone: ( ) �390 - 2 93 3 <br /> Mailing Address:,3,�_R2 7614 h/S#AzN Z� 5Y--6 CA-7 AZ %SZ/Z <br /> 5. Number of Food Booths: 2 G <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age: 74/-5 <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: Yes ❑ No <br /> 3. Are janitorial facilities available: Yes ❑ No <br /> 4. Number of toilets provided: /Gz <br /> 5. Name of sanitary garbage disposal company: _!` 16e1 f _ Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths:�i_rr k T�`j 23,2_ 1J <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$172 <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 /> • $172 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$774.00 <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: •J 15/76 Z S_ <br /> 1868 E. Hazelton Avenue J Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/0112024 <br />