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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> - r <br /> lyr�y( � LDJ <br /> TEMPORARY EVENT APPLICATION "EC 0 4 2017 <br /> To be completed and signed by Event Coordinator, then returned to the EnvironmentMORNOMt with all <br /> of the Food Vendor's Applications no later than two weeks prior Mar�SE�VICes LT14 <br /> GENERAL EVENT FILE INFORMATION <br /> 1, NameofEvent: OUR LADY OF GUADALUPE FESTIVITIES KERMESS <br /> 2. Date(s)of Event: DECEMBER 10 , 2017 Time of Event: 9 : OOam to 7 : OOpm <br /> 3. Location: 16200 CAMBRIDGE DR . LATHROP, CA. 95330 <br /> 4. Event Coordinator (Name): JOSE CARLOS FLORES Telephone: {209 814-6730 <br /> Mailing Address: 16200 CAMBRIIDGE DR. LATHROP, CA. 95330 _ <br /> 5. Number of Food Booths: 7 ( seven ) <br /> 6. Approximate attendance at peak time: 300 Total Attendance: 500 Average Age: 0--c)9 <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: ❑X Yes ❑ No <br /> 4. Number of toilets provided: 4 <br /> 5. Name of sanitary garbage disposal company: REPUBLIC SERVICES Number of dumpsters: 2 _ <br /> 6. Method of disposal of liquid waste for food booths: DRAINS <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 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-1 or 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: S t <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3117 <br />