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P� osti � �� � <br /> SA N.. ,J OAQU 1 N Environmental Health Department <br /> COUNTY— <br /> - .�_ Gren�ne5s �roFvs 1�Fr:., <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: r5 <br /> 2. Date(s) of Eve . l IZ30 Time of Event: ,� <br /> 3. Location: 5 z�-- <br /> 4. Event Coordinator(Name):Ty��rr��' sf�/mss /-`/u6 Telephone: (Zay) <br /> Mailing Address: z <br /> 5. Number of Food Booths: fi Grp u <br /> 6. Approximate attendance at peak time: Svc-70UTotal Attendanc D- )PO Average Age: s- k0 <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: _y Qud-, <br /> 5. Name of sanitary garbage disposal company: ✓1`3mo&W Number of dumpsters: 3 <br /> 6. Method of disposal of liquid waste for food booths: ��rfur �CcvesSf�In <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$179 <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 /> • $179 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$805.50 <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: Y 1�,� �u�,�r�r�� 7 -y-Z36 Date:_ P, -6), <br /> .nnn r i ___ ._ _ n.._._.._ i r.a__.�__ i._rt_ __._ nrnnr i r nnn •nn nnn r nnn •n. n�nn i _____.__ �_�.___ ___.e_�_ <br />