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SAN J O A Q U I N 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: .ri'k R r-CA.0g <br /> 2. Dates) of Event: P&AQ t_lS�r- !�_,Z.0 t9� Time of Event: <br /> 3. Location: �2s g . k-4Aa,1 <br /> c 5 s t'rR��C L_Oac, CA �Lu <br /> 4. Event Coordinator(Name): Telephone: (LO% 333 - fo8't <br /> Mailing Address: I2.S' S. 4tt+dai 2 SCom, cks-Z-{L�) <br /> 5. Number of Food Booths: 1 <br /> 6. Approximate attendance at peak time:4y v Total Attendance: �` -� Average Age: 0 <br /> UTILITIES <br /> (Zt0) <br /> 1. Is potable water supplied and available for each food vendor: �es ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Vs ❑ No <br /> 3. Are janitorial facilities available: �s ❑ No <br /> 4. Number of toilets provided: _ 21 <br /> 5. Name of sanitary garbage disposal company: N 1. C <- i- n grxmL,rr umber of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: )Alg_:Ae_ *"cord <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: Date: `3 O (� <br /> 1868 E. Hazelton Avenue I Stockton, 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 /> 06/19/19 <br />