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- S A N J OA Q U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <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: r w.vv�J�ent: <br /> O.rrLv� \ 7�n1}e 14 <br /> 2. Date(s) of Event: g Tim 6:3D - l� Vv� <br /> 3. Location: I L24j - <br /> 4. Event Coordinator(Name):IPA V-.10-. L%2cc` �1 Telephone: (off_5S753 <br /> Mailing Address: _)_{ry-21,l -¢.1ycfL �r-t� T ,, P ,vv XC� `- <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: 300 Total Attendance: 00 Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: SKes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: I es ❑ No <br /> 3. Are janitorial facilities available: L14/(es ❑ No <br /> 4. Number of toilets provided: t WCJ \ <br /> 5. Name of sanitary garbage disposal company: 4­ Saga LLB & dumber 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$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: �� Date: 1 �� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP 0713117 <br />