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sJOAQUIN <br /> <br />Environmental Health Department <br />OUNTY <br />ess grows here <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 />Name of Event: NQ \OA. (X ('))C4/\CYN,, <br />Date(s) of Event: Unt. -2:-.)1 ‘ Time of Event:I i L I ( 5 " 5 : ' C 1 C ki '01.\ <br />Location: Ski ()V\ '.-k--a <br />Event Coordinator (Name): Q..(3.1 k(,), \1021.k_a__ Telephone: 9041-14-4 6 S fib 0 <br />Mailing Address: 1--37) ,L A•CCO.ckY..., (--1 :1\--CCIk.A.,\I-0, QA' ces-)L.6.4 <br />Number of Food Booths: (1\ <br />Approximate attendance at peak time: 0 Total Attendance: go Average Age: >14,( Yq-ed <br />UTILITIES <br />Is potable water supplied and available for each food vendor: .E1Yes El No <br />Is electricity supplied and available for each food vendor: ,EYes El No <br />Are janitorial facilities available: n No <br />Number of toilets provided: S <br />Name of sanitary garbage disposal company: Number of dumpsters: <br />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 />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />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 tettiporary event coordinator, I am responsible for meeting California State <br />standards and the E vir mental Health Department policies and procedures. <br />Event Coordinator: Date: i‘64 <br /> <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP na inn 1•111,3