Laserfiche WebLink
S A N d O A Q U I N 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: !� +�Lf� <br /> 2. Date(s)of Event: R <br /> Time of Event: <br /> 3 Location: <br /> 4, Event Coordinator (Name): <br /> G' Teiephone: (Zaq `j <br /> Mailing Address: �I3 � ��Xl1as�'f✓ '�� ��`�� �'� C Q <br /> 5. Number of Food Booths: rntr! yPlZ15 <br /> Average Age: <br /> 6. Approximate attendance at peak time _I?Total Attendance: <br /> UTILITIES <br /> 1, Is potable water supplied and available for each food vendor �es ❑ No <br /> 2. is electricity supplied and available for each food vendor: `Yes ❑ No <br /> 3. Are janitorial facilities available: <br /> [ Yes ❑ No <br /> 4. Number of toilets provided: �f <br /> 5. Name of sanitary garbage disposal company: <br /> VJ Number of dumpsters:d"0 <br /> 6. Method of disposal of liquid waste for food booms: <br /> APPLICATION <br /> 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 5162 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site P,an <br /> e) Food Vendor List <br /> 2. If the event is seltcted 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 5729.00 <br /> This application is to be completea/I Food Vendor's Applications no lat signed by the Event 1e rfhan ttwo weeks hen returned <br /> for to the <br /> Environmental Health Department with <br /> event. <br /> I understand that as a temporary event coordinator, <br /> l policies andsponsibl proceduees.r meeting California rate <br /> standards and tine Fnvironrnentai Health Dep <br /> Date: <br /> : <br /> Event Coordinator: <br /> _1 <br /> b exit _ <br /> 18fi8 E. kiazelton Avenue I Stockton California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgcy org/ehd <br /> y- <br />