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s A N J Q A Q U I N Environmental Health Department <br /> c o u il: - <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: !' - rn n Se eie id <br /> 2. Date(s)of Event: I Time of Event: A4 Ei1s 064 &4 , <br /> 3. Location: - !o NEI <br /> 4. Event Coordinator(Name): k-F'-!9A PF_REj t2A Telephone:{JM 1712 <br /> Mailing Address: t' j7e�r-Alric l i Co <br /> 5. Number of Food Booths: I <br /> 6. Approximate attendance at peak time: 1 t t.�, Total Attendance: IL-11 K� ... Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: 5 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: <br /> 5. Name of sanitary garbage disposal company: 1_L!NS L))IIA141 =p !Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: S'R1N/ h-iRUSiEu + <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 he 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 /> 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._ l 1 L , L LLfi ti Date: <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 ] F 209,464-0138 1 www.sjgov.org/ehd <br /> EHd 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/01/2024 <br /> P�05-2+5�q <br />