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SAN -J QAQ U I 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: -- <br /> 2. Date(s) of Event: G .2 2"Time of Event: Z�*;Z ti?W1 A,d111 , Z(s� �DI�M—g�M� <br /> 3. Location: 40/ /�++ lV �✓M�'� <br /> 4. Event Coordinator(Name): QI� ✓ LpW1WuyCAe€ephone: (20J) "I "�'t�, <br /> Mailing Address: I t S.S�'L1C.�G*m Pak �2,O�n��43�- CAN- k(l64 b Iy1DLsu�_ <br /> 5. Number of Food Booths: !V_ <br /> 6. Approximate attendance at peak time: 00 Total Attendance:20000 Average Age: 40 <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes & No <br /> 2. Is electricity supplied and available for each food vendor: ❑Yes IQ No <br /> 3. Are janitorial facilities available: ❑Yes 14 No <br /> 4. Number of toilets provided: Z n _r <br /> 5. Name of sanitary garbage disposal company: Cl iK lvwov., Number of dumpsters: tCj <br /> 6. Method of disposal of liquid waste for food booths: O'SPbSkk <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 I Stock on, California 95205 ! T 209 468-3420 f F 209 464-0138 J www.sjgov.org/ehd <br /> EHD 16-02 Page 1 of 11 TEMP EVENT APP <br /> 07/01/2025 <br />