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T2 Sc z3 6A <br /> SAN 10AQUIN Environmental Health Department <br /> --COUNT-Y <br /> TEMPORARY EVENT APPLICATION <br /> To be completed and signed by Event Coordinator, the returned to <br /> n than the <br /> weeks Environmentalprior to Healtevent Department with all <br /> of the Food Vendor's Applications <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: a t <br /> 2. Date(s)of Event: Z02CP Time of Event: <br /> 3. Location: r C p <br /> 4. Event Coordinator(Name): ��� -_ Telephone: OW) o <br /> mod. C,►�+ze.K fior� A �215 <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: _Total Attendance �� Average Age:tYl <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: es ❑ No <br /> 3. Are janitorial facilities available: '' Yes ❑ No <br /> 4. Number of toilets provided: Arj�} VVV� <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 /> ,i6) Application Review Fee o 179 <br /> Zc) Temporary Food Vendor A ations for each booth <br /> mod) Temporary Event Site Plan <br /> X) Food Vendor List <br /> 2. If thent is selected for inspection, the Event Coordinator will be billed for inspection time: <br /> •/ $179 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$805.50 <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: I�'Y h{i 1��cco�_— Date: <br /> 1868 E. Hazefton Avenue + Stockton, California 952051 T 209 468-3420 F 209 464-0138 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 0710112025 <br /> _ <br /> Piz z'�)a3n_T e,( <br />