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S A Kd O A Q U f N Environmental Health Department <br /> COU NTY— <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: e tY be FT via <br /> 2. Date(s)of Event: �1Q1'CG, O, �014 1 Time of Event: 160AW h00, 1�-xi <br /> 3. Location: M e*-e►ra n Nel,:t+a j <br /> 4. Event Coordinator(Name): (�glraet v MoLJ icl Telephone: (190) q6 Q- `!506 <br /> Mailing Address: 3�2 1-r O_p l Aoi0 4 1 i ya u -- lalOJV4", 0­2 <br /> 5. Number of Food Booths: t vo '�506-7'klS <br /> 6. Approximate attendance at peak time: Total Attendance: 66-170 Average Age: .z <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes ❑ No N Q <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes ❑ NoD0-�f/15` <br /> 3. Are janitorial facilities available: ❑ Yes ❑ No �J <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <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 �(� ) Dl�92 <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 the <br /> hourly rate, calculated at one and one half times ($228 per hour) <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: a Date: 3-`�- <br />