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s 9 r�_ <br /> ,4U�ti <br /> S iQ NJ oA Q N Environmental Health Department <br /> COUNTY— <br /> Greatness 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 /> 1. Name of Event: G. <br /> 2. Date(s)of Event: J�U.f Time of Event: <br /> 3. Location: <br /> 4, Event Coordinator(Name): f Telephone: (j(}J)! Lp5- <br /> Mailing Address: 2el!S_ 1-141 eWO 4 L.>n • Ctyly1'1' CCA I r'C'L• C4 5 65 7 <br /> 5. Number of Food Booths: A- <br /> 6. Approximate attendance at peak time: LO�0 Total Attendance: If Dd Average Age: ski; Gqa� <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes lii No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes o <br /> 3. Are janitorial facilities available: ❑ Yes XJo <br /> 4. Number of toilets provided: 5 Cku"L"7 <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: Z-. <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$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 wlth all Food Vendor's Applications no later than two weeks prior to the <br /> event. <br /> 1 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 I F 209 464-0138 1 www.sjgov.org/ohd <br /> EH0 16-02 Page 1 of 11 TEMP EVENT AP <br /> 071G112025 <br />