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Environmental Health Department <br />laiviName of Event:1. <br />2. <br />3. <br />4. <br />5. <br />6.Approximate attendance at peak time: Total Attendance: Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />7/^lnDate:Event Coordinator: <br />TEMP EVENT APPPage 1 of 11 <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 />EHD 16-02 <br />08/01/16 <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />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 />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: <br />'ID) <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />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 the <br />hourly rate, calculated at one and one half times ($228 per hour) <br />kA]^/^/Zc^/fl^jmber of dumpsters: <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greatness grows here. <br />TEMPORARY EVENT APPLICATION^ <br />To be completed and signed by Event Coordinator, then returned to the Environmental Hegp^ <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />JUL 05 201? <br />Pe^/se&^th <br />3pmDate(s) of Event: <br />Location: A/ .■ <br />GENERAL EVENT FILE INFORMATION <br />/no <br />Time of Event: 10pm <br />poin-y Events <br />ClxYVyg ri ‘S i rpS_____Telephone: ( ) <br />c vRc C- <br />0 Yes No <br />jZf Yes No <br />Yes No