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FROM FAX NO. .n. 29 2013 1:34PM P2 <br /> "' . S�N JOAO�I Environmental Health Department <br /> viro ep rtment <br /> N T Y <br /> rE'atne's grows n,?re. <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 /> GENERALF <br /> WENT FILE INFORMATION <br /> 1. Name of Event: <br /> 2. Date(s)of Event.- Time of Event <br /> 3. Location: `e <br /> 4. Event Coordinator(Na ): elephone: ( / <br /> Mailing Address: <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: Average Age:. _:L10 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor. ❑Yes CR/No <br /> 2. Is electricity supplied and available for each food vendor C] Yes ER No <br /> 3. Are janitorial facilities available: Yes El'N <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: umber of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: <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 Departmen with all Food Vendor's Appillications 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 proc;edures- <br /> Event Coordinator: Date <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> Received Time Var, 14, 2019 2 ; 39PM No. 4797 P89e10111 TEMP EVENTA➢P <br />