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SAN JOAQUIN Environmental Health Department <br /> -- COUNTY— - <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: W 10 QiO616�e SA- <br /> 2, Date(s) of Event: a , MaC^,h G3,aWLfTime of Event: <br /> 3. Locatiun: mms <br /> 4. Event Coordinator(Name): Telephone: IVQ) 09 6 J(009 <br /> Mailing Address: cat U W-e CA gn37 <br /> 5. Number of Food Booths: Lk <br /> 6. Approximate attendance at peak time: 35D Total Attendance: W50 Average Age: 1 � <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes d o <br /> 2. Is electricity supplied and available for each food vendor: ElYes [NNo <br /> 3. Are janitorial facilities available: ❑ Yes 9No <br /> 4. Number of toilets provided: (Q <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: y all W)JOrs ore <br /> (5ev�—C al neJ <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 /> 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: /J�� Date: J_ OU <br /> 1866 E. Hazelton Avenue I Stockton, California 952051 T 209 =468-3420 � F 209 464-0138 I wwvv.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> nr,r2a»n73 <br />