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SAN 10AQUIN Environmental Health Department <br /> - -COU N-Y- - <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: �,JfcJ<�/fe �y<a2�vFirr X,9,� <br /> 2. Date(s) of Event: cP,!:: Time of Event: <br /> 3. Location: P rY- ,ha 72& <br /> 4. Event Coordinator(Name): Telephone,0,0� <br /> Mailing Address: <br /> 5. Number of Food Booths: �y <br /> 6. Approximate attendance at peak time: �� Total Attendance: �' D O 0 Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes X No <br /> 2. Is electricity supplied and available for each food vendor: ❑ Yes K No <br /> 3. Are janitorial facilities available: �N Yes ❑ No <br /> 4. Number of toilets provided: /G =� <br /> 5. Name of sanitary garbage disposal company: Z11 Y Number f dump`sters: 7` <br /> 6. Method of disposal of liquid waste for food booths: Z� � � J <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$156 <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 /> • $156 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$702.00 <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 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 I Stockton, 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 />