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.� SAN.J OAQU I N <br /> Environmental Health Department <br /> t COUNTY <br /> nt,, •.� GrotvF Herr. <br /> TEMPORARY EVENT APPLICATION Healthturned to the Environmental department with all <br /> To be completed an of the Food Vendor's Applications nod by Event Coordinator,then elater than two weeks prior to event <br /> GENERAL EVENT FILE INFORMATION s r �n PtS4'Va� <br /> 1. Name of Event: Time of Event: ( � <br /> 2. Date(s)of Event: : �Z 2 ` !j �' <br /> 3. Location: 1-1 S Y K• U�� <br /> des Telephone: (Zd� <br /> 4. Event Coordinator(Name): 3 3 <br /> Mailing Address: er <br /> Fay p-!mod <br /> 5. Number of Food Booths: Average Age:�^ <br /> Total Attendance: <br /> 6. Approximate attendance at peak time:�_�2� <br /> w a+, is de va►l a b i' fj tr�- <br /> .UTILITIES hr i n �e►t'"o{"r <br /> ❑Yes XNo YendnrS �x11 vt <br /> 1. is potable water supplied and available for each food vendor. ❑Yes �No F li•e ckr. �k{ lS CLVOL i 10.bI�b <br /> Uey-LowV9 LoMsuppkl <br /> 2, is electricity supplied and available for each food vendor: Yes �No <br /> 3. Are janitorial facilities available: n <br /> 4_ Number of toilets provided:_� — f r d W�t!t 3 <br /> .St7�� Number of dumpsters: �!, <br /> 5. Name of sanitary garbage disposal company:' 1•r� 17SQ0��I �I�utO� w � �+ <br /> 6. Method of disposal of liquid waste for food booths: 3 G� f <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 oil be bllled 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 <br /> Coordter inator, <br /> then <br /> weeks ned to the <br /> far to the <br /> Envfronmontal Health Department with all Food Vendor's Appll no <br /> event. <br /> 1 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 Ccordinator; <br /> Data: <br /> 1868 E. Haxelton Avenue I ockton, California 95205 I T 209 468-3420 1 F 209 464-01138 1 www.sjgov.orglehd <br /> EHa 18-02 TEMA EVENT APP <br /> 071GI12024 <br />