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S A N ,,:f O A 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: 17,00,� 1 rt ck- Frer?Zu and a 14,o v,`e__ <br /> 2. Date(s)of Event: Se- ep bar- ,"3 rd Time of Event: U U <br /> 3. Location.. /40-Ad'.E `j ��r <br /> 4. Event Coordinator(Name): Telephone: 6o?.3 /,-2/ <br /> Mailing Address: 6 vZ L• .S e e h llelei' l <br /> 5. Number of Food Booths: 1- <br /> 6. Approximate attendance at peak time: 0 otal Attendanc Average Age: v <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes allo <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes .E5W <br /> 3. Are janitorial facilities available: �/ El Yes �No <br /> 4. Number of toilets provided: r� <br /> 5. Name of sanitary garbage disposal company:Ci Ll J F M An teC61,_ Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: C .Q. e,r r-e <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$156 <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 /> • $156 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$702.00 <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 J 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 />