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Environmental Health Department <br />Time of Event:. <br />c. <br />Average Age: Total Attendance: <br />Number of dumpsters: <br />1. <br />2. <br />Event Coordinator: <br />5. <br />6. <br />Temporary Event Application <br />Application Review Fee of $162 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br /> No <br /> No <br /> No <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 />1868 E. Hazelton Avenue <br />EHD 16-02 <br />nemn/onoQ <br />per- vV, tAyQ <br />ZjYes <br />Yes <br />EfYes <br />SAN JOAQUIN <br />C O U N " v <br />Name of Event: . <br />Date(s) of Event <br />Location: <br />Event Coordinator (Name):_ <br />Mailing Address: ^t/-j <br />Number of Food Booths. <br />Approximate attendance at peak time: <br />—Da,e 51 ZTTzif•’CaliforHa 95205 | T 209 468-3420 | F 209 46<0138 | ^^jgov^ LL_ <br />GENERAL EVENT FILE INFORMATION <br />1. <br />2. <br />3. <br />4. <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <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 />APPLICATION <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) <br />b) <br />c) <br />d) <br />e) <br />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 tc> the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to. the <br />M^erstand that as a temporary event coordinator, I am responsible for meeting Califomia State <br />standards and the Environmental Health Department policies and procedures. <br />IfL Cl <br />MVK( <br />.. <fr> L! DhX L V (p i-x (,\A tr^^Telephone: Z11- | <br />1 1 I •-