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TEMPORARY FOOD SERVICE APPLICATION - page 2 / 6

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         FOOD

thaw

 cut/

assemble

cook/

bake

 cool

cold

holding

reheat

 hot

holding

portion

package

2)  Please complete the following section if application is for a BOOTH;

a)   If food preparation is required, list name of restaurant to be used or kitchen facility under Health Department permit.

Kitchen name_____________________________Address______________________________________________________

Dates and Times Kitchen Used____________________________________________________________________________

b)  How will you provide temperature control for potentially hazardous foods?  Foods must be 41o  F or colder, or 140oF or hotter.  MONITOR THEM FREQUENTLY. Circle as many as you will be using.

Hot holding;  steam table, oven, BBQ, gas grill, wok, steamers, stove, hot holding case, other (list)______________________

Reheating or cooking:  oven, BBQ, gas grill, wok, steamers, stove, other (list)______________________________________

Cold holding:  refrigerator, refrigerated truck, refreezable ice/cooler, dry ice/cooler, drained ice, freezer, other_____________

During transport:______________________________________________________________________________________

c)  List personnel for the event (if you don’t know who is working yet, provide a name list with Health Cards at the booth forthe       

NAME

  Health

   card?

   Exp.

   date

 NAME

   Health

     card?

    Exp.

    date

1.

4.

2.

5.

3.

6.

d)  Describe booth:

Floor__________________________Roof_________________________________Walls_____________________________

*Walls and ceilings must be made of wood, canvas, or other material that protects the interior of the booth from dirt and weather.

ADDITIONAL REQUIREMENTS:

1)  Gravity flow handwashing facilities must be provided in your booth.  This consists of an insulated container with a spigot that can lock in open position - capacity of 5 gallons or more - filled with hot water, a tub or bucket for waste water, pump soap and paper towels.  WASH HANDS FREQUENTLY!

2)   Sanitizer for wiping rags must be provided in your booth.  This solution consists of 1 tablespoon of bleach per gallon of water (or other approved sanitizer) and wiping cloths.

3)   Stem-type thermometers are required if you serve any potentially hazardous foods.  Monitor temperatures frequently.  

4)   Leak-proof garbage containers must be provided in your booth.

5)   Water must be obtained from an approved source.

6)   Waste water must be disposed in a sanitary sewer.  Disposal in storm drains or on the ground is unacceptable.

7)   Restrooms must be provided for your employees.  Restrooms must have handsinks with hot and cold running water.  HEPATITIS A and other illnesses can be spread by foodworkers who don’t wash their hands after using the bathroom.  WASH HANDS BEFORE RETURNING TO THE BOOTH.  (Portable toilets are not allowed unless portable handwashing facilities with HOT water, soap and paper towels are provided).

8)   Dishwashing facilities must be provided by you or the event coordinator if you are preparing food at the event.  Soap and sanitizer must also be provided.

APPLICANTS SIGNATURE_____________________________________________________ DATE:________________________

I understand that issuance and retention of any permit is contingent upon satisfactory compliance with Grant County Health District requirements.  $30.00 of each refund will be retained by the Health District for administrative expenses.

GRANT COUNTY HEALTH DISTRICT

PO BOX 37, EPHRATA/1038 W IVY ST MOSES LAKE

509-754-6060 EPH/509-766-7960 ML

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