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SAN ,J OAQU I N Environmental Health Department <br /> ' •'i`� ff COUNTY 0� <br /> sEP <br /> ENv1Ro °G 2019 <br /> TEMPORARY EVENT APPLICATION NMEN <br /> To be completed and signed by Event Coordinator, then returned to the Environmental Health DeT <br /> of the Food Vendor's Applications no later than two weeks prior to event CFS Ty <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: ke Lk)�•t }c A ?3yt_kti1 - W� V-k $e-e.,�st <br /> 2. Date(s)of Event: Sal .tkaA u � ter�hje r Time of Event: 1 Z PM - `I PM <br /> 3. Location: 2-80 1,L , av,�: to I C6 r'1 S3 <br /> 4. Event Coordinator(Name): O^ C r1 Telephone: (:­i) W 7,V_ <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: j DOO Average Age: ^ <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 [54 No <br /> 3. Are janitorial facilities available: ❑ Yes [�PNo <br /> 4. Number of toilets provided: 9 <br /> 5. Name of sanitary garbage disposal company: C,6k%A Wa4,t UAangAe_ywu._A Number of dumpsters: 1 S r4�rJ <br /> 6. Method of disposal of liquid waste for food booths: See ali-kc-W all venc(or> qvo self-&,;r�.9eA <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 California State <br /> standards and the Environmental Health Department policies and procedures. <br /> Event Coordinator: 91 IV Date: g I s l n <br /> 1868 E. Hazelton Avenue I Stockto , California 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 /> 06/19119 <br />