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S A N J OA Q U I 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: r <br /> 2. Date(s)of Event: 2 3 Time of Event: <br /> 3. Location: <br /> 4. Event Coordinator(Name): . s Telephone: Q�f &9) 3( - -71go <br /> Mailing Address: -t)5. y. t kl end.. 4t . <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: k5t M0 Total Attendance: Average Age: �3 _ <br /> UTILITIES <br /> 1, Is potable water supplied and available for each food vendor: ❑ Yes [V4'No <br /> 2, Is electricity supplied and available for each food vendor: [ Yes ❑ No <br /> 3. Are janitorial facilities available: ❑ Yes WN0 <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: Number of dumpsters: <br /> 6. Method of disposal of liquid waste for food booths: ( �j1d►� <br /> APPLICATION a ?D50A <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$162 <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 /> • $162 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$729.00 <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 /> understand that as a temporary vent coordinator, 1 am responsible for meeting California State <br /> standards and the Environmental th Department policies and procedures. ' <br /> Event Coordinator: Date: �G <br /> 1868 E. Hazelton Aven I Stoc ton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 16-02 Page 1 of 11 TEMP EVENT APP <br /> 06129/2023 <br />