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SA N J OAQ U I N Environmental Health Department <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 t <br /> 1. Name of Event: ��,Y� (.iA t,! ``�� lei 4\.1. t �% <br /> 2. Date(s)of Event: n t " Time of Event: l <br /> 3. Location: 1, �� ;` 1 ' [; t L- . <br /> 4. Event Coordinator(Name): 1�UN1101 Telephone: <br /> Mailing Address: .'�`� 1��)(; �` �T1,�(1h /f, •�'� �.�lt'� <br /> 5. Number of Food Booths: �) <br /> 6. Approximate attendance at peak time: ('('� Total Attendance: Average Age: _ <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: [JYes ❑ No <br /> 2. Is electricity supplied and available for each food vendor: Q Yes ❑ No <br /> i <br /> 3. Are janitorial facilities available: 0 Yes ❑ No <br /> 4. Number of toilets provided: _ - <br /> 5. Name of sanitary garbage disposal company: �i1L ,1�,�� �. Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths:('* <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 Departme 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 /> 06/19/19 <br />