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SAN JOAQUIN Environmental Health Department <br /> "=OU N-T <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: I W ko Q <br /> 2. Date(s)of Event: , m(Xr(,�( Time of Event: <br /> 3. Location: (Y1C�,1�S IrA A� 1'33 NJ. C-)caf t y mC ,l �?53rY�►1a <br /> 4. Event Coordinator(Name):`�i11'�` a ?3UX' laC� Telephone: f�) 0or?J' —W%9 <br /> Mailing Address: U Wit CA g5330 <br /> 5. Number of Food Booths: "A <br /> 6. Approximate attendance at peak time: 1650 Total Attendance: W50 Average Age: _q0 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor ❑ Yes o <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes o <br /> 3. Are janitorial facilities available: ❑ Yes ZNo <br /> 4. Number of toilets provided: (d <br /> 5. Name of sanitary garbage disposal company: �� Number of dumpsters: �4- <br /> 6. Method of disposal of liquid waste for food booths: a4QbV6 —all W*6 Girt° <br /> (5evq-con+ai nee <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$162 <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 /> • $162 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$729.00 <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: blmv- Date: ✓ Woaq <br /> 1868 E. Hazeltun Avenue I Stockton, Califorlua 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orcglehd <br /> EHo 16-W Page 1 of 11 TEMP EVENT APP <br /> nFr7cnm� <br />