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S A NA A Q U I N Environmental Health Department <br /> COUNTY <br /> G eatnr.-ss Crops 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: 17vv Track- Frenz,y and A 141)vie- <br /> 2. Date(s) of Event: S e_CJ—ZJT b 3 rd Time of Event: 5 U <br /> 3. Location: 0ozJ1114' r C <br /> 4. Event Coordinator(Name): Telephone: <br /> Mailing Address: aZ L h Ae,J " (A <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: QL_Total Attendance:Leo Average Age:�(� <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 .[!�No <br /> 3. Are janitorial facilities available: ❑ Yes allo <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company:C._4q J /CWJ� f/00,_- plumber of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths ' :twoweeks <br /> APPLICATION1. Submit the following to the Environme`tal H alth Department prior to the event <br /> a) Temporary Event Application\b) Application Review Fee of$1c) Temporary Food Vendors Applicatoons fore__- _.boo <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: �/ l <br /> 1868 E. Hazelton Avenue 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 />