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t-I`I �AN 10AQUIN Environmental Health Department <br /> z 11,E h�.' ---COUNTY-- <br /> Greatness grows here <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: fi W W% �?_rQ1C 5 <br /> 2. Date(s)of Event: 1. AYAV_�4 . MCVCV� n- , ZiALTime of Event: plat rl �}Pm <br /> 3. Location: 5 � C^Vek►'—�l A It try `i <br /> 4. Event Coordinator(Name): M Telephone: (-101) F (4,11-1- <br /> Mailing Address: _2ZZ `u n W LLS.- ,` y-)n kCf.rl <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance:_`Jt Y.> Average Age: y U <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes 0 No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes ® No <br /> 3. Are janitorial facilities available: ❑Yes [g No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: C.{-i.-i 6-C (VV-t ( ,, Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: f e(ci ..-Cv-,ckUrS `•mac sCk{ -<<.'kM0 ,* <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 a <br /> minimum three-hour overtime rate of$684.00 <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 Califomia State _ <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: Date: MC1 A-) '7-, <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 06/19/19 <br />