Temporary Food Service Application FORM – English Required Contact Information TEMPORARY FOOD SERVICE PERMIT APPLICATION Date(s) and Time of Operation: (use the back of the sheet for additional dates: First Location All food must be prepared at the temporary food booth or at a permitted, commercial kitchen approved by the health department. Home prepared foods cannot be served and use of home prepared foods may result in closure of your booth. Will all foods be prepared at the temporary food booth? Yes No If no, list the name and address of the permitted establishment where foods will be prepared Menu Items Additional Questions 1.During all hours of operation, at least one person must be present with a Food Handler Permit or a FoodSafety Manager Certification. Who will have this permit or certification? 2.Will you serve hot foods at the event? Yes No (If no, skip to question 6.) 3.Food for hot holding must be kept at 135o F or above. How will you maintain hot foods at 135o F or above? 4.Food must be cooked to proper temperatures. Hamburgers and other ground beef products must be cooked to 155o F for 15 seconds. Poultry products must be cooked to 165o F, and pork to 155o F. How will you ensure that food reaches the proper cooking temperature? 5.Previously cooked food for reheating must be cooked to 165o F within 2 hours. How will you rapidly reheat food to 165o F? 6.Cold foods must be kept at 41o F or below. How will you keep cold foods at 41F or below? 7.All food must be prepared in the temporary booth or in a commercially approved kitchen. Food prepared away from the event must be transported properly in order to maintain temperatures. How will you maintain proper food temperatures during transport? 8.Wastewater must be disposed of properly in a sanitary sewer. Where will you dispose of wastewater fromyour booth? 9.Everyone in the booth must have hair restraints. How will workers restrain their hair while working in the booth? 10.Dishes and equipment must be washed, rinsed, and sanitized in the booth or a commercially approved kitchen. How will you wash, rinse, and sanitize dishes, equipment, and utensils? 11.A hand wash station is required in the food preparation area. Where will your hand washing station be setup in the food booth? 12.All food and paper products must be stored off the ground. Where will you store your food and paper products? 13.Your booth must have a roof or cover, two side walls, a front service wall, and a floor. The floor must be a surface of plywood, concrete, asphalt, grass, or other acceptable material. Attach a drawing of your booth here: PLEASE NOTE: We need a detailed, descriptive picture or drawing that shows the EXACT layout of your booth. Please do not just attach a picture of the food truck or tent. We need details about a hand-washing station, etc. Max File Size: 2MB Or for larger files provide a public link to DropBox, or GoogleDrive, so that we can download your files: Digital Signature I have received the Food Safety Guide for Temporary Events. I will read the guide before the event described above and I agree to abide by the rules outlined. I understand that failure to abide by the food safety standards set forth in the guide increases the risk of causing food borne illness and may result in the closure of my food booth. By typing your name below, you are signing this form electronically. You agree to, and understand, all the information you are submitting: Click the SEND button only once. It will take just a moment to process your information. You will receive a confirmation email if your submission was successful.