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S A N 4,1 O A Q U I N Environmental Health Department <br /> COUNTY <br /> Greotness 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: S�,E6 yes <br /> 2. Date(s)of Event: J(),-►e Time of Event:oyo <br /> 3. Location: Do -)n fcx-v n `�'}�ii r'I fe4 6- <br /> 4. Event Coordinator(Name): coon ti/t Re f Telephone: (34) �a44--b <br /> Mailing Address: 163 U-2 „ Lod S-, Sfe to , (I &,1 fe&, . L A '7-1)3 J(�, <br /> 5. Number of Food Booths: o� <br /> 6. Approximate attendance at peak time: /60 _Total Attendance: 6Z0,�Average Age: �d—J <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes P3 No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes ® No <br /> 3. Are janitorial facilities available: ❑Yes ® No <br /> 4. Number of toilets provided: 1 to <br /> 5. Name of sanitary garbage disposal company: rn.� Mi 1lfe « Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: c i � <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: vii✓ � Date: <br /> 1868 E. Hazelton Aven 11 Stockton, California 95205 1 T 209 468-3420 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 />