NEW Temp Food Application

Temporary Food Permit Application
Name*

First NameLast Name
Email*
example@example.com
Address of Applicant/Business*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Event*
Location of Event*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates*

MonthDayYear
Please select a date at least 2 days in the future. If you are applying for a permit for an event within 48 hours, you will need to call the environmental health desk to see if accommodations are possible.
Time food will be served*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Person(s) in charge of booth*

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.

All condiments (ketchup, mustard, sugar, salt, etc.) must come from individually packaged containers.

At least one Food Safety Manager or food handler card must be present at the location.

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.

Select Permit Category*

Category 1

Food that DOES NOT require time/temperature specific regulations. (Ex. candy, soda, popcorn).

$20.00

Category 2

Food that DOES require time/temperature specific regulations. (Ex. hot dogs, chicken, hamburgers).

$150.00

Total

$0.00

I have read the requirements on this application and agree to comply with these and any other instructions from the TriCounty Health Department.*

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