Fillable ANIZER APPLICATION page 1 of 3 COMMUNITY FOOD (Merced College)

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ANIZER APPLICATION page 1 of 3 COMMUNITY FOOD (Merced College)

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page 1 of 3
EVENT
1. NAME OF EVENT
2. LOCATION OF EVENT
3. CITY
4. DATES OF OPERATION
5. HOURS OF OPERATION
DEPARTMENT OF PUBLIC HEALTH
D
ivision of Environmental Health
COMMUNITY FOOD EVENT ORG
ANIZER APPLICATION
Directions: This application must be completed and submitted to this office by the event organizer at least two weeks prior
to the event, along with a completed and signed Community Food Event Vendor Application for each booth or food vehicle
that will sell or give away food or beverages at the event. Provide all information requested. Incomplete applications
may delay approval.
260 East 15
th
Street
Merced, CA 95341
(209) 381-1100
(209) 384-1593 (FAX)
http://www.countyofmerced.com/eh
Equal Opportunity Employer
ORGANIZER
6. SPONSORING ORGANIZATION
7. CONTACT PERSON
8. MAILING ADDRESS 9. CITY 10. STATE
11. ZIP 12. EMAIL 13. PHONE # 14. CELLPHONE #
WHO
15. EXPECTED ATTENDANCE
16. NUMBER OF FOOD VENDORS/BOOTHS
ATTACH A COMPLETED
COMMUNITY EVENT FOOD
VENDOR APPLICATION
FOR EACH BOOTH.
17. MAJORITY OF EXPECTED ATTENDEES’ AGE
<7 YEARS OLD GENERAL POPULATION >50 YEARS OLD
FACILITIES
17a. WILL POTABLE WATER FROM AN APPROVED SOURCE BE PROVIDED
TO THE FOOD VENDORS?
YES, (source: ) NO
17b. WILL POTABLE ICE FROM AN APPROVED SOURCE BE PROVIDED TO
THE FOOD VENDORS?
YES, (source: ) NO
18. WILL TOILET FACILITIES BE PROVIDED FOR FOOD WORKERS?
YES: # permanent / portable NO
CHAPTER 11: Section 114359. Toilet facilities
(a) At least one toilet facility for each 15 EMPLOYEEs shall be provided within 200 feet of each TEMPORARY FOOD FACILITY.
19. WILL ELECTRICITY BE PROVIDED FOR EACH FOOD VENDOR?
YES: # NO
20. ARE JANITORIAL FACILITIES AVAILABLE?
YES: # NO
METHOD OF DISPOSAL OF LIQUID WASTE FOR FOOD BOOTHS:
21. WILL GARBAGE DISPOSAL DUMPSTERS/CANS BE AVAILABLE?
YES: # NO
NAME OF GARBAGE DISPOSAL COMPANY (if applicable):
I, , have read the Community Event guidelines and understand what is
expected of me in order to operate my community event. I have provided all required attachments (specified on page 2).
Organizer’s Signature:
FOR OFFICE USE ONLY:
Date:
A/R No:
PAID: Invoice#
________ $_______
Exempt: ______________
TE#:____________
CE#:____________
APPROVED:
Date:
Rev. 10/18/18
page 2 of 3
٭All of the following must be completed and attached to your application for approval:
(CHECK OFF BOXES AS YOU COMPLETE THEM)
Community Event Food Vendor Applications
Community Event Food Vendor List (application PAGE 2)
Community Event Site Plan (application PAGE 3)
Copy of flyer and/or public newspaper advertisement for the event
Copy of the form/letter which shows approval from City /County Parks & Recreation Department OR a letter from
property owner granting authorization for the event to occur on their property (if applicable)
COMMUNITY EVENT FOOD VENDOR LIST
NAME OF BOOTH(S) / ORGANIZATION(S)
(Booth # refers to their location on your site plan)
Count of Facilities/Booths
(Refer to each food vendor application)
Mark all applicable for each vendor.
Booth
#
BOOTH / ORGANIZATION
NAME
OPERATOR NAME CONTACT #(s)
MAIN FOOD
ITEM (1)
/ MOBILE
PROFIT/ NON-
PROFIT
DD214/
COUNTY/
CITY OR
DISTRICT
page 3 of 3
COMMUNITY EVENT SITE PLAN
Provide a diagram of the layout of the event indicating the following:
FOOD VENDORS (please # them)
JANITORIAL FACILITIES
ROADS (provide names)
GARBAGE AREAS
RESTROOMS
OTHER:
WATER SOURCE(S)
EVENT NAME: EVENT DATES:
Note: This diagram does not have to be drawn to scale, but linear measurements must be provided for restroom distances from food vendors.
N
↑
Use symbols below
FV# Food Vendor as listed G Garbage Area W Water Source(s)
Restroom Facilities Janitorial Facilities (to dump waste water)
RR J
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ANIZER APPLICATION page 1 of 3 COMMUNITY FOOD (Merced College)

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Completed 5 September 2020

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