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SAN JOAQUIN COUNT . <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 1868 East Hazetton Avenue S# 9520u V ockton, CA 5-62Wd <br /> X. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjq: v. 2 <br /> ENVIRONME <br /> PERM;TSERvJc�CrH <br /> TEMPORARY EVENT APPLICATION ES <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,Y%,A <br /> 2 Date(s) of Event: �-,+oixr I- $ 1_ _Time of Event: VY. A ti <br /> 3. Location- Ck <br /> 4 Event Coordinator(Name): Telephoner-r `j- �5 <br /> Mailing Address: O n'tM CA <br /> 5. Number of Food Booths: 8 <br /> 6. Approximate attendance at peak Total Attendance: -j`'! J�36 Average Age: 3'J <br /> A` r <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes ZNo <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes O'No <br /> 3 Are janitorial facilities available: ❑ Yes ❑ No <br /> 4 Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company ri ' T ft-) S Ec �� Number of dumpsters: C� <br /> 6. Method of disposal of liquid waste for food booths: L+Wn VI q 14A1r -ro �N'M .� �� <br /> C faQRY -aLfT `T H Cif a+ry k\ <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$125 <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 /> • $125 per hour(weekdays 8:00 am to 5:00 pm) <br /> • After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br /> hourly rate, calculated at one and one half times ($183 per hour) <br /> This application is to be completed and signed by the Event Coordinator, then retumed 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 tempqra event coordinator, I am responsible for meeting California State <br /> standards and the Environ nt I ealth Department policies and procedures. <br /> Event Coordinator: Date: 2 ! fj <br /> % <br /> EHO 16-02 Page 1 of 11 TEMP EVENT APP <br /> 712W10 <br />