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PRZSvn3�? , <br /> S A N °1 O A Q U I N Environmental Health Department <br /> -COUNTY <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 y, <br /> 1. Name of Event: r J a n a I gS A 1 �C A <br /> 2. Date(s)of Event: D 4 OLS Time of Event: <br /> 3. Location: �J��1J��y✓GY 1� a e C p5 <br /> 4. Event Coordinator (Name): !-tom Telephone: (1 l� 6 10 — 01 <br /> Mailing Address: 1s!, D f e afsa ey ACE. Maw, C AR 5 <br /> 5. Number of Food Booths: 2- <br /> 6. Approximate attendance at peak time: Total Attendance: Sig D Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: 211yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: [ Yes ❑ No <br /> 3. Are janitorial facilities available: <br /> ^ n L� Yes ❑ No <br /> 4. Number of toilets provided: S V <br /> 5. Name of sanitary garbage disposal company: Mam4tcq av L a Number of dumpsters.- <br /> 6. Method of disposal of liquid waste for food booths: -.1 q <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 /> 0 $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: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wwwsjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 0710V2024 v` <br />