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•4�!9 <br /> ' ! —COUNTY cg1 <br /> Greatness VOWS here, SUS <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: I I . IV'4-1A ('.0 11 VI 1 a.l«.�• <br /> 2. Date(s)of Event: 0,Q G►' , 7-•'`(_.___Time of Event: 10 A W - to Q aA <br /> 3 Location: .. t- „„ i i -- f-r r A- — <br /> 4 Event Coordinator(Name)._1 _��_� Telephone. <br /> Mailino Address `� —�� -- <br /> 5 Number of Fond Booths <br /> 6 Approximate attendance at peak time ____Total Attendance: Average Ag FC <br /> UTILITIES <br /> 1 Is potable water supplied and available for each food vendor. 0 Yes; [No <br /> 2 Is electricity supplied and available for each food vendor: ❑Yes E] No <br /> Are janitorial facilities available Yes Pi No <br /> e Number of toilets provided <br /> 5 Name of sanitary garbage disposal company , Number of dumpsters: <br /> 6 Method of disposal of liquid waste for food booths <br /> APPLICATION <br /> Submit the followina to the Environmental Health Department two weeks prior to the event <br /> a) Temporary Event Application <br /> b) Application Review Fee of$162 <br /> c) Temporary Food Vendors Applications for each booth <br /> d i Temporary Event Site Plan <br /> el Food Vendor List <br /> 2 If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br /> $162 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$729.00 <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: <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Paye f of 1 I TEAIP EVENT APP <br /> 06/29/2023 l <br />