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SAN -J OAQ U f N Environmental Health Department <br /> 14 <br /> 1 / -COUNTY— <br /> �Itjfproqx r! Greatness grows here, <br /> Mq <br /> TEMPORARY EVENT APPLICATIOIIW���Ro� <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Healtll�, ent all <br /> of the Food Vendor's Applications no later than two weeks prior to event NSF qC y <br /> �h��s pry <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: A A2M <br /> 2. Date(s) of Event: S&V%XaGk%S , AS. - Time of Event: , 01 Arm <br /> 3. Location: S• u wito A Qi- % Uj1 �u;� ,.� ' y �wi _,, CA <br /> 4. Event Coordinator(Name):_�Jj�1S` _Telephone. (,�Ltq Ds ao,14 <br /> Mailing Address: LAXX10 Tt;�4Nc L.1A (S_U Ll SPA CA qSZ 52 <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: a. Total Attendance: So D Average Age: ' <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes E5<( o <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes ®QVo <br /> 3. Are janitorial facilities available: ❑ Yes JXNo <br /> 4, Number of toilets provided: —1 <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: , <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 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: M Date: 2y 25 <br /> 1868 E. Hazetton Avenue J Stockton, California 95205 J T 209 468-3420 J F 209 464-0138 J www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07JO112024 <br />