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S A N 11 J aA Q U I N Environmental Health Department —COUNTY— TEMPORARY EVENT APPLICATION To be completed and signed by Event Coordinator,then returned to the Environmental Health Department with all of the Food Vendor's Applications no later than two weeks prior to event GENERAL-EVENT FILE INFORMATION 1. Name of Event: le S 0 0 f Ge, Q S 2. Date(s) of Event: U h4e_ V3'-h 2,010 Time of Event: —3 rrn 3. Location: I ward Lje, of cL RS33� 4. Event Coordinator(Name):UcL S5a Me.f'lcjoZo7 _ Telephone: (M) $t` 41.I Mailing Address: 0q rtr e_ S if- 103$ te(Q A_ Q5337 5. Number of Food Booths:-- I EoM True •t p .ems 6. Approximate attendance at peak time:!Qrn --Total Attendance: 00 Average Age:_Q_:�0_0 UTILITIES 0.gQi1ab#e_ �atcr Is 1. Is potable water supplied and available for each food vendor: ❑Yes Z No to ui- Veridor5 tot It br►ram 2. Is electricity supplied and available for each food vendor. ❑yes `-Vv`ir U W� �Nb t i 5 n o i-o vo_kLoL a 3. Are janitorial facilities available: `Yes ❑No 4. Number of toilets provided: y 5. Name of sanitary garbage disposal company:MmifCoL SOIL d L'47'i'k-Number of dumpsters: 3 6. Method of disposal of liquid waste for food booths: Ven a w otts lh 65id lk�urd was+c o APPLICATION 1. Submit the following to the Environmental Health Department two weeks priorto the event: a) Temporary Event Application b) Application Review Fee of$152 c) Temporary Food Vendors Applications for each booth d) Temporary Event Site Plan e) Food Vendor List 2. If the event is selected for inspection, the Event Coordinator will be bllled for inspection time: • $152 per hour(weekdays 8:00 am to 5:00 pm) • After regular business hours(weekday,weekends and holidays)the inspection Is charged at a minimum three-hour overtime rate of$684.00 This application is to be completed and signed by the Event coordinator, then returned to the Environmental Health Department with all Food Vendor's Applications no laters prior to tt3a event I understand that as a temporary event coordinator, I am responsible for meeting California State standards and the Environmental Health Department policies and procedures, Event Coordinator: Date:_ � 267 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 4W34201 F 209 464-0138 www,s}gov.orgiehd �o to u2 t�r» TEMP evENTAaa OG�Wip - �'25jm02.