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SAN?10AQUIN <br /> Z. —COUNTY— <br /> Greatness°G Environmental Health Department <br /> `; <br /> c9� �... Greatness grows here. <br /> TEMPORARY EVENT APPLICATION E MAY 09 <br /> ►vvl ll 9 <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health DepW& all <br /> of the Food Vendor's Applications no later than two weeks prior to event MlT/SER�CF �hI <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: r w+rNw--P� �o+'�-`�� s`► <br /> 2. Date(s) of Event: g Time of Event: <br /> 3. Location: I62GC OrL- IVS!'L �.fi o�J�Co� r1s�f fo <br /> 4. Event Coordinator(Name):IDA NV,\OL- �.. v �►�y 1 Telephone: (2� '7 (4\--SS53 <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: D Total Attendance: '-2,p 00 Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: E Yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Wes ❑ No <br /> 3. Are janitorial facilities available: EXes ❑ No <br /> 4. Number of toilets provided: � *- � R•1!�W�� t ' * � �.., y <br /> 5. Name of sanitary garbage disposal company: 6% t L'��i•n• So1,1A �Plumber of dumpsters: 1 <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$152 <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 /> • $152 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 ($228 per hour) <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: �~r �� Date: sz�31 19 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHB 16-02 Page 1 of 11 TEMP EVENT APP <br /> 0713/17 <br />