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SAN JOAQU N Environmental Health Department <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: 1 Via _.r ~ v <br /> 2. Date(s)of Event: I Time of Event: <br /> 3, Location: 1 ? It (� il: L /)(} <br /> 4. Event Coordinator(Name): t Telephone: <br /> Mailing Address: 11) <br /> 1 ' IA � . <br /> 5. Number of Food Booths: Ir) J <br /> 6. Approximate attendance at peak time:1,' /1/�0 Total Attendance:J Average Age: <br /> UTILITIES <br /> 1. is potable water supplied and available for each food vendor: [yYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor. { Yes ❑ No <br /> 3. Are janitorial facilities available: I eyes ❑ No <br /> 4. Number of toilets provided: � r"�f}` 11 11 It <br /> 5. Name of sanitary garbage disposal company: �1 t `,1,tf4._l Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: l'. <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$162 <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 /> $162 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$729.00 <br /> This application is to he 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, 4Date: <br /> _LL 17-, ;� j <br /> !Safi E. Iliizolton Avenue 15toukton, California 9520 T 209 468-312.0 I F 200 464-0138 1 %vww.sj9ov.orq1!r;lid <br /> EHD 16-02 Page 1 or 11 1 LMP EVEN I APP <br /> 06!2912023 <br />