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S A N ! OA Q U I N Environmental Health Department <br /> t- - ulv . - <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: !�1 d-�-e ?)rCxo <br /> 2. Date(s) of Event: m C C) Time of Event: �/'[� q <br /> 3. Location: ]�}� ��rC�fl 41 Q � mczn- =�A�,�L� - — <br /> 4. Event Coordinator(Name): J Telephone: (a0q) Y <br /> Mailing Address: �QA U <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: '3D Total Attendant : 3 r Average Age: 5�-'15' <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: 4yes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: LC.Yes F <br /> 3. Are janitorial facilities available: f 5/Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: UQk- QA Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: A\\ (;ESt� CO'nAC4lr)J6 <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$172 <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 /> $172 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$774.00 <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 /> evellL <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: <br /> I Date: a 1 a l i� <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcdov.grglehd <br /> EHO 16-02 Page 1 of 11 TEMP EVENT APP <br /> f17tt117f196 <br />