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2. <br />3. <br />4. <br />5. <br />6. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />1868 E. Hazelton A' <br />EHD 16-02 <br />07/01/2024 <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />ya) 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 /> No <br /> No <br /> No <br />Environmental Health Department <br />received <br />SANJOAOUIN <br />-----COUNTY------ <br />Greatness grows here. <br />n Z t-tf s <br />California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pagel of 11 , TEMP EVENT APP <br />GENERAL EVENT FILE INFORMATION <br />1. <br />'' go ■ <br />% <br />0 Yes <br />0 Yes <br />E Yes <br />Number of toilets provided: - /’ph <br />Name of sanitary garbage disposal companv:~Z?^/?y Derr a Number of dumpsters: <br />Method of disposal of liquid waste for food booths: i/y^y \ <br />V A \ | <br />o\zJ “Tr8 <br />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 />yTinHP#* r kiotJs <br />Event Coordinator/ / // <br />6 'MT] /J <br />Stock! <br />MAY 1 9 2025 <br />TEMPORARY EVENT APPLICATO)UEf™L HEALTH <br />To be completed and signed by Event Coordinator, then returned to the Environmental all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />Name of Event: X /- Gkc ch- f <br />Date(s) of Event: Yx,/u/, Time of Event. <br />Location: FuU/nei- 5z: 4.53'76______ <br />Event Coordinator (Name): '77?/?zy Telephone: (20-) <br />Mailing Address: A/ 7-Z. <br />Number of Food Booths: (j) f Se-k&( <br />Approximate attendance at peak time: TV Total Attendance: yzy- 707 Average Age: