FOOD TO BE SOLD/SERVED

COMMUNITY EVENT TEMPORARY FOOD FACILITY APPLICATION
(*Submit 30 days in advance of the event)

*Application submitted less than 14 calendar days prior to the start of the event will be subjected to an expedited processing fee.
Name of Event
Date(s) of the Event

Month Day Year
Date
to
Name of Facility
Event Organizer
Facility Operator
Booth #
of Food Employees
Address

Mailing Address

Street Address Line 2

Zip
City
Telephone
Fax
E-mail
example@example.com
Address

Event Address

Street Address Line 2

City

Zip
On-site Phone
TEMPORARY FOOD FACILITY TYPE:
FOOD OPERATION TYPE

Food Booth Food Truck Food Cart Annual Food Booth Pre-packaged Pre-packaged with Sampling Food Demonstration Food Preparation
FOOD TO BE SOLD/SERVED
All food preparation shall be completed either in the temporary food facility or at an approved food facility.

List food items to be sold/served:
Identify types of preparation at booth

(unopened, original containers) Check if commercially pre-packaged: Identify types of preparation at other
teriyaki chicken, burrito, popcorn, etc
Check if commercially pre-packaged:

Identify means of temperature control at booth:

(unopened, original containers)

	-	-	-	-

(unopened, original containers)

	locations: cutting, washing, cooking, etc	assembly, portioning, cooking, etc	steam table, refrigerator, ice chests, etc

OFFICE USE ONLY:
Date Received

Month Day Year
Date
Amount Paid
Invoice #
Approved By
FOOD PREPARATION AT OTHER LOCATION
All food preparation must be completed either in the temporary facility or at an approved food facility. Identify any facility where advanced

preparation will take place. An agreement form must be submitted for food preparation at a permitted food facility.
Name of Facility
PR/Permit #
Address of Facility
Method of food temperature control used during transportation
HOT/COLD HOLDING EQUIPMENT
Identify methods of maintaining food hot or cold during hours of operation.
Cold Holding

Mechanical Refrigerator Ice Chest Cold Table Steam Table Chafing Dishes Electric Soup Warmer Hot Holding Cabinet Hot Dog Roller Grill Electric Rice Cooker/warmer Other (Specify)
At the end of the operating day, all potentially hazardous foods that are held at 45°F shall be destroyed. At the end of the operating day, all potentially hazardous foods held at or above 135°F shall be destroyed.
EQUIPMENT/UTENSILS USED
Will multi-use kitchen utensils knives, scoops, spatulas, bowls, etc be used inside the booth for food preparation?

Yes No
Identify all equipment that will be used in food preparation at the food booth

Barbecue Grill Range Burner Deep Fryer Griddle Charbroiler Mixer Blender Other (Specify)
Identify all utensils that will be used in food preparation at the food booth
Multi-use eating and drinking utensils are prohibited (plates, glassware, etc
FOOD PROTECTION
Identify methods of protecting foods from customer contamination.

Sneeze Guards Only pre-packaged food or bottled drink Hinged chafing dishes Prepared and stored away from the customers Other
(Specify)
FOOD BOOTH CONSTRUCTION
Food preparation booths must be constructed with 4 sides, a washable floor and overhead protection.

Pre-packaged food booths require a washable floor and overhead protection.
Floor Material
Wall Material
Ceiling Material
Size of Pass Through Window
SINK REQUIREMENTS
Warewashing sink (one per four temporary food facilities) with hot and cold running water under pressure provided by:
For temporary food facility operating for less than 4 hours adequate supply of spare utensils may be provided in lieu of a warewashing sink. Handwashing sink with warm and cold running water provided by *

Event Organizer Pre-packaged only (not required) Temporary Food Facility Operator (complete Liquid Waste Disposal section)
For temporary food facility operating for less than 4 hours adequate supply of spare utensils may be provided in lieu of a warewashing sink. Handwashing sink with warm and cold running water provided by

Event Organizer Pre-packaged only (not required) Temporary Food Facility Operator Complete Liquid Waste Disposal section
Type of handwashing sink

Permanently plumbed sink Self-contained portable sink Gravity fed unit
Water Source
Volume of Water
LIQUID WASTE DISPOSAL
Liquid Waste Removal Provided By

Event Organizer TFF Operator Connected to public sewer Waste tank
Method of Liquid Waste Removal:
Waste tank
Waste tank maintenance schedule
per day
Provide the name, address and telephone number of Person(s) responsible for removal of liquid waste:
Name
Address
Telephone
the operating day in a manner approved by the enforcement agency.
the operating day in a manner approved by the enforcement agency.

Clear
I have completed the application to the best of my ability. I understand that I may be asked to provide additional information in order for the application to be approved and that the information provided is considered part of the application.

I understand that failure to meet the conditions identified in this application or failure to comply with requirements set forth in the California Health and Safety Code may result in the disposal of food, suspension of my approval to operate and/or may result in the filing of misdemeanor criminal charges.

I understand that once the application is reviewed, the permit fee is non-refundable, including any expedited processing fee.
Print Name
Telephone
Signature

Clear
Cell Phone
Should be Empty: