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SKJ OAQU I N Environmental Health -` W19 ms� ) <br /> �._ ----COUNTYD <br /> Greatness grows here MAY Q 9 2022 <br /> ENVIRONMENTAL <br /> ESLTI j <br /> TEMPORARY EVENT APPLICATION pERM1T/SERV►C <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 C _ <br /> 1. Name of Event: tAy1 CG:u(,_r, ' i c�4� - S U �. iree_ G,I <br /> 2. Date(s)of jnt: J LA L T�'l t S Time of Event: 10 ..0D ��.: 0 C) p p <br /> 3. Location: ( ` rt A4 CCk d O 2 <br /> 4. Event Coordinator Name : �- <br /> (Name) I �' jv 11 h elephone: Qi% c?R 3 " <br /> Mailing Address: <br /> 5. Number of Food Booths: C 2 Lf 5,0 <br /> 6. Approximate attendance at peak time: /et C Total Attendance: ( C 0L Average Age:`'f! <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 XNo <br /> 3. Are janitorial facilities available: ❑Yes $ 'No <br /> 4. Number of toilets provided: i�-7 <br /> 5. Name of sanitary garbage disposal company: e�M01+P_CO3 Number of dumpsters:�- <br /> 6. Method of disposal of liquid waste for food booths: re � e bo.i-e- 1 <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 a <br /> minimum three-hour overtime rate of$684.00 <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: <br /> 1868 E. Hazelton Avenue 11 Stoe ton, California 95205 1 t(09 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 06/19/19 <br />