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2 x ur-�t,ta`3Vl-1�V11E �-._.. _....-----�.'- - ---._.. �—ram••----�... <br /> --COUNTY-- c I <br /> Greatness grows there. SC � � l <br /> TEMPORARY EVENT APPLICATION 0� b9 Sb <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: o, <br /> 2. Date(s)of Event: Time of Event: 10 r\yV , <br /> 3. Location: C- _i. v <br /> 4. Event Coordinator(Name). e., = Telephone: { :r: ) t,,- c y ;T• <br /> Mailing Address i ►I <br /> 5 Number of Food Booths- <br /> 6. Approximate attendance at peak tin1e " Total Attendan e: Average Ag . �� <br /> UTILITIES <br /> 1 Is potable water supplied and available for each food vendor: ®Yes(_PI:N <br /> 2 Is electricity supplied and available for each food vendor: ❑Yes Q No <br /> 3 Are janitorial facilities available: Yes No <br /> 4 Number of toilets provided. _ q _ <br /> 5 Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6 Method of disposal of liquid waste for food booths: (' v r { <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 S162 <br /> c) Temporary Food Vendors Applications for each booth <br /> d) Temporary Event Site Plan <br /> e) Food Vendor List 1 i � }� set v• L� �c �{Y��� <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$729.00 <br /> This application is to be completed and signed by the Event Coordinator, then returned to the <br /> Environmental Health Department with all Food Vendor's Applications no later than two weeks prior to the <br /> event. <br /> understand that as a temporary event coordinator, I am responsible for meeting California State <br /> standards and the Environmental Health department policies and procedures. <br /> Event Coordinator: ! ;' Date: `•` L.y Y <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orgiehd <br /> EHD 1"2 Page 1(it 1$ TEMP EVENT APP <br /> D6;29r2023 <br /> C- 1 \\J 1-A-1 e 5 4 dl O+a . o e—A— <br />