Temporary Food Establishment Permit Application
Name
*
First Name
Last Name
Email
*
example@example.com
Address of Applicant/Business
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Event
*
Location of Event
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dates
*
-
Month
-
Day
Year
Time food will be served
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Person(s) in charge of booth
*
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Food Safety Information
Food Preparation Requirements
All foods must come from an approved source (NO HOME CANNED FOODS ARE PERMITTED).
All time and temperature controlled foods including meats, dairy products, poultry and other related foods must be cooked at the correct temperatures listed below.
Required Internal Food Temperatures
At least 130°
At least 135°
At least 145°
At least 155°
At least 165°
Whole roast beef
Commercial pre-cooked foods
Shelled eggs
Ground, chopped, or injected meats
Poultry and other foods filled with meat and or stuffing
Fruits & vegetables
Meats such as; whole muscle fish, beef, and pork
Food should be prepared and cooked on site or in a regulated food establishment kitchen.
A thermometer will be on hand with a range of 32-165°.
Hot foods must be kept at 135° or higher.
Cold foods must be kept at 41° or lower.
All condiments (ketchup, mustard, sugar, salt, etc.) must come from individually packaged containers.
Ice must be dispensed from an approved container using a handle scoop.
At least one Food Safety Manager or food handler card must be present at the location.
Sanitation Requirements
Ready-to-eat food must not be handled with bare hands. Gloves, deli paper, tongs, or other utensils must be used to handle food. The public is not permitted to serve themselves food from a communal container (ex. bags of buns or chips with their hands).
Hand washing stations must comply with the following requirements:
Includes soap, paper towels, clean, running water (a hand-dipping bucket is not adequate).
Include sanitizer that follows proper temperature and concentration: clorine: 50 to 100 ppm at 75°, or Quats:200 ppm at 75°.
Be within 10 feet of the cooking area.
Hands must be washed before putting on gloves, handling food, between each glove change, and after handling money.
Plastic utensils, paper plates, napkins, and other single serve items must be stored off of the floor/ground.
Garbage must be properly bagged prior to discarding into a main refuse/garbage container.
The booth or area must be constructed in order to minimize the entrance of flies, vermin, dust and any other form of contamination.
The cooking area must be restricted from the public.
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Where will food be prepared?
*
Menu Items
*
Select Permit Category
*
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( X )
Category 1
Food that DOES NOT require time/temperature specific regulations. (Ex. candy, soda, popcorn).
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Category 2
Food that DOES require time/temperature specific regulations. (Ex. hot dogs, chicken, hamburgers).
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
I have read the requirements on this application and agree to comply with these and any other instructions from the TriCounty Health Department.
*
Submit
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