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�— Cy_gT-� C <br /> pVIN - <br /> Q'° c°� S A N�� Q N �L t ot-�--z <br /> Environmental Health Department <br /> COUNTY <br /> cgrro¢��� Greotness 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: T�Wl AI YIMOr►d. 61 o on SEn 114 <br /> 2. Date(s) of Event: Time of Event:: 1? 21e: 1Drrn-Spy►' <br /> 3. Location: 4*, Awl, lV "r <br /> 4. Event Coordinator(Name): elephone: (2M) <br /> Mailing Address: 10 t <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: ov Total Attendance: DO Average Age: 4V <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑Yes 19 No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes &No <br /> 3. Are janitorial facilities available: ❑Yes Ij No <br /> 4. Number of toilets provided: Z n __rr-- <br /> 5. Name of sanitary garbage disposal ClAA 0' _ V�ct7 A Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: WMAC., 0%%_TDSkk <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 Hea Department policies and procedures. <br /> Event Coordinator: Date: <br /> 1868 E. Hazelton Avenue 1 Stoc n, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/0112025 <br />