Laserfiche WebLink
S A N J 0 AQ U I N Environmental Health Department <br /> y <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 <br /> 1. Name of Event: A ND L_ <br /> 2, Date(s) of Event: Q f ! L-0'2--6 Time of Event: 3 PM <br /> 3. Location N1 o L/WE a i 1�j "US t< Ct*Q T9-A t- (PA IL 1L <br /> 4, Event Coordinator(Name): J MDM ILL gP,.S y Telephone: (6/4 :7 36 -- 1796 <br /> Mailing Address: Qf N ' T MovnrT41W 1-1)u5E — 9 3 <br /> 5 Number of Food Booths: <br /> 6. Approximate attendance at pe Total Attendance: Average Age a me: 25 <br /> UTILITIES <br /> 1 Is potable water supplied and available for each food vendor. Yes D No <br /> 2 Is electricity supplied and available for each food vendor: El Yes N No <br /> 3. Are janitorial facilities available: Yes ❑ No <br /> 4. Number of toilets provided: 6 <br /> 5. Name of sanitary garbage disposal company: W-5 T ✓mot-pry D f-1 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$179 <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 /> • $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 /> 22-."(! T�2 <br /> Event Coordinator: Date: c�3 <br /> 1868 E Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> FWD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07f0112025 <br />