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SA N J OA Q U I N Environmental Health Department <br /> -COUNTY----- <br /> Grratness grows hcrr. <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 INFORr <br /> VIATION <br /> 1. Name of Event: L/ <br /> 2. Date(s) of Event: Time of Event:Jam <br /> 3. Location: Do,n V-,Q n- LAAA <br /> 4. Event Coordinator(Name): Telephone: VA <br /> Mailing Address: . ' 1 7 <br /> 5. Number of Food Booths: <br /> 6. Approximate attendance at peak time: Total Attendance: LW- ) Average Age: _ <br /> UTILITIES <br /> 1. Is potable water supplied and available for each food vendor: ❑ Yes dN0 <br /> 2. Is electricity supplied and available for each food vendor: [v(Yes ❑ o <br /> 3. Are janitorial facilities available: ❑Yes , NNo <br /> 4. Number of toilets provided: <br /> 5. Name of sanitary garbage disposal company: k. *tuber of dumpsters: � (h � <br /> 6. Method of disposal of liquid waste for food booths: <br /> APPLICATIONr -ram <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 H Ith Department policies and procedures. <br /> Event Coordinator: )AAAC Date: <br /> 1868 E. Hazelton Avenue tockton, California 05 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHd 1"2 Page 1 of 11 TEMP EVENT APP <br /> 06/19/19 <br />