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GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />6.Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />Method of disposal of liquid waste for food booths: 6. <br />APPLICATION <br />1. <br />2. <br />then returned to the <br />event. <br />responsible for meeting California State <br />Date: <br />EHD 16-02 <br />08/01/16 <br />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 $139 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />Name of Event: <br />Date(s) of Event: <br />Location: ^373- s <br />Event Coordinator (Name); <br />Mailing Address: S- <br />Number of Food Booths: | <br />Approximate attendance at peak time: 4-OP <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health DepartmenF&kta&7» <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />I L-MWI a I z , knUUfMUl I, <br />re/ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $139 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($208.50 per hour) <br />This application is to be completed and signed by the Event Coordinator, i.'.... <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />Is potable water supplied and available for each food vendor: PfYes No <br />Is electricity supplied and available for each food vendor: ^fVes Q No <br />Are janitorial facilities available: [EfYes Q No <br />Number of toilets provided: portable (rf/tn)o <br />Name of sanitary garbage disposal company: ^^0^4noerrt~Number of dumpsters: I <br />Method of disposal of liquid waste for food booths: <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: Date: <br />P^ae l afTI | J TEMP EVENT APR <br />Total Attendance: noo <br />c_Annual <br />iMi Time of Event: 1I PhA <br /> Telephone: SG>