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SAN.JOAOUIN <br /> Environmental Health Department <br /> _.—COUNTY <br /> grow,% here. <br /> �ircoli+�ss <br /> TEMPORARY EVENT eAPPLICATION d to the Environmental Health Department with all <br /> To be completed and signed by Event Coordinator,the <br /> of the;~Dad Vendor's Applications no later than two weeks prior to event <br /> GENERAL.EVENT FILE INFORMATION FtS4i VaQ <br /> 1. Name of Event: <br /> `',- Z Time of Event: <br /> 2. Date(s)of Event: y <br /> 3. Location: �, S <br /> Vr7LhQ (Za`b <br /> 4. Event Coordinator(Name): SA - (]� Telephone: 3 3 <br /> Mailing Address: er <br /> rq cK p—&0 <br /> 5. Number of Food Booths: Average Age: <br /> /Q <br /> 6 ApproximateTotal Attendance: <br /> attendance at peak time:�� <br /> ay,-e,r ►'s oe vY1►i t cc b(e <br /> .UTILITIES m <br /> IES r W+11 bran �k4e%i oto <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes f�No Ife.Ylddo S <br /> lied and available for each food vendor: ❑Yes �'Na Ej ec4-rLc,k 4 <br /> 2. is electricity supplied ji]'Yes No Uetnp(u�-S tu►i1 SL P(aj j ` hiLiv <br /> 3. Are janitorial facilities available: Dwh <br /> 4. Number of toilets provided: a S.011d w�'� 3 Number of dumpsters: G!f <br /> 5. Name of sanitary garbage disposal t;;� Posa r i�cl � � f* <br /> 6. Method of disposal of liquid waste for food booths: 7 <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 rlor to the <br /> event <br /> understand that as a temporary event coordinator, I am responsible for meeting Califomia State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator. Data: <br /> 1868 E. Hazelton Avenue 11 nekton,California 95205 1 T 209 468-3420 j F 209 464-0138 1 www.sjgov.org/ehd <br /> FHR 1"2 Page 1 of 11 TEMP EVENT APP <br /> 0710112024 <br />