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SA N J DA W N Environmental Health Department <br /> - COUNTY <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: _ 1!C'.;� 1 J'-C, Y <br /> 2. Date(s)of Fveni /,�"�GCL 9 5 / 4 a:�' L' ;.i- Time of Event: <br /> 3. Location: LI L.c'7`]fL�'Z•v' ..l ( i.l< �. <br /> 4. Event Coordinator(Name); L t 1 " Telephone: ( ) "U'/ <br /> Mailing Address - <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: ?f Total Attendance: ;c_ <<: Average Age: <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes 7 No <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: c�)7,/ <br /> 5. Name of sanitary garbage disposal company: Oeqj '' )161 j. c -i ! Number of dumpsters: *A&-(It-A ii <br /> 6. Method of disposal of liquid waste for food booths: y` 1�l a 11,S, /.'4 <br /> Ix �� Y <br /> APPLICATION /i v�� <br /> tits 75 k',-S <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$152 <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 /> • $152 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$684.00 <br /> This application is to be completed and signed by the Event Coordinator, then returned to the <br /> Efrviron►r ental Health Department with all Food Vendor's Applications no later than two weeks prior to the <br /> event. <br /> understand that as a temporary event coordinator, 1 am responsible for meeting California State <br /> standards and the Environmental Health Department policies and procedures, <br /> Event Coordinator: ' ''G` �'u ' L 'r Date: <br /> 1868 E. Haxelton Avenue I Stockton, California 95205 1 'T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 16-02 Pagel of 11 TENIP EVENT Arr' <br /> 661+9l19 <br />