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S A N J UQ u ;I N Environmental Health department <br /> C_ Ui_, NTY <br /> i 1- <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: ro 4-M <br /> 2. Date(s)of Event: ObT — GGI fiti �aTime of Event:, bpi ���� �� L1W <br /> 3. Location: C4 f?t-6 E1V r v F3 T G [PN EA/ P- !r 5C, ( DO <br /> 4. Event Coordinator (Name): 4GM 4k f"i'd 9g K elephone: (Ll C lob _ <br /> Mailing Address: 0,1 5 �3 <br /> 5. Number of Food Booths: 1/`1E 8l����r�, D0 {� �7VO <br /> � <br /> 6. Approximate attendance at peak time: � , -- Total Attendance: ooc) Average Age: <br /> UTILITIES <br /> 1. is potable water supplied and available for each food vendor: Yes ❑ No 3 O D <br /> 2. Is electricity supplied and available for each food vendor: Yes ❑ No <br /> 3. Are janitorial facilities available: ( ,Yes ❑ No <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: (d j!f d f {Yllf7 Number of dumpsters:. J <br /> 6 Method of disposal of liquid waste for food booths: ffloLfd 1/44L tEft'C- W 7WE N(1111 <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$605.50 <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 Environmen i Health Department policies and procedures. <br /> Event Coordinator. ' Date: �� 0 <br /> 1868 E. Hazelton Avenue I Sto kton. California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 1"2 Page 1 of i 1 TEMP FVENT APP <br /> 07/0112025 <br />