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SAN JOAQUIN Environmental Health Department <br /> – COUNTY— <br /> C(a <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: l v�� ,"e1e 16 <br /> ry o <br /> 2. Date(s) of Eve 78 ZS f34 Time of Event: ,t„ 42.,12, 1 <br /> 3. Location: ��,� ,` Oa/ 3/5 /'� Y�� X376 <br /> 4. Event Coordinator(Name): 4::�/u6 Telephone: (Zi--) gf! 736 <br /> Mailing Address: _Z 0; E i��y/7G zMeacu 7 ------y --- <br /> 5. Number of Food Booths: I vy>S tr_�fP� f2IL1j <br /> 6. Approximate attendance at peak time: 506-?00Total Attendance: SpO-700 Average Age: /S-- -110 <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: Yes ❑ No <br /> 3. Are janitorial facilities available: © Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company-, _T�'� ��� _ ✓15d0S&/Number of dumpsters: 3 <br /> 6. Method of disposal of liquid waste for food booths: Grr�,f�Y SCcv�rSt�r <br /> APPLICATION <br /> 1. Submit the following to the Environmental Health Department two weeks priorto 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, l am responsible for meeting California State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: ���� �Cm ✓���s / .�������736Y Date: !'i l �� C�2�� <br /> nnn r r _�_r.__ e.._.___ i r.•__r.•_._ n_r.e___._ nrnnr r r nnn snn nnn r r nnn •nnnn r ..___ _ ___... __.r_t� <br />