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S A N J O A Q U I N Environmental Health Department <br /> COUNTY <br /> Gre©tness brows 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 FoodMPL- <br /> dor's Applications no later than two weeks prior to event <br /> ��, � SAS ��A9-, <br /> GENERAL EVENT FILE INFORMATION <br /> 1. Name of Event: ++ Y�.Le- CA�r <br /> 2. Date(s) of Event:SCE, r_ Time of Event: Ia-�vn- �A PY <br /> 3. Location: <br /> 4. Event Coordinator(Name): T e I e "C phone: ( 8Z3- (pZ2Z <br /> Mailing Address: ?JZZ S u y% Wka-AAe c-o- C-R 9 S15-5-7 <br /> 5. Number of Food Booths: H <br /> 6. Approximate attendance at peak time: 5rOy Total Attendance: O v 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 No <br /> 3. Are janitorial facilities available: ❑Yes No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal companyf�tAS4 11,)a-Ae- na.Grvy"- Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food boothsSGe.a\ta YwA-ak\ NvAr�ot S cLc S<<�--C&-(4�vve.d <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 the <br /> hourly rate, calculated at one and one half times ($228 per hour) <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 Coordinato Date: `i� J21 <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/3/17 <br />