Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Application For - Temporary Event Food Booth Permit

Please put N/A for any fields that are not applicable

Event Name
Location
Event Coordinator
Phone Number
Food Booth Owner
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Booth Contact Person
Phone

Requested Permit Dates
First Date
Last Date
Time of Operation
Hours of operation
 
Number of Booths Requested


Application and Permit Fee Schedule
Level of Hazardous Food

Choose only one - Either Tier 1 or Tier 2
Tier 1 - Three or fewer foods that require time/temperature control for safety.
Permit Fee - 72 hours prior to event:   $20.00   Quantity:   Item Subtotal:  
$0.00
*Per Booth/Per Day
Late Permit Fee-Less than 72 hours prior to event:   $35.00   Quantity:   Item Subtotal:  
$0.00
*Per Booth/Per Day
 
Tier 2- More than three foods that require time/temperature control for safety.
Permit Fee - 72 hours prior to event:   $40.00   Quantity:   Item Subtotal:  
$0.00
*Per Booth/Per Day
Late Permit Fee-Less than 72 hours prior to event:   $55.00   Quantity:   Item Subtotal:  
$0.00
*Per Booth/Per Day
Total:
$0.00
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method

Commissary Name
Contact Name
Address/City
Phone
Menu Items


Applicant agrees that maintenance of a health permit is predicated on compliance with the Utah Code R392-100 (Food Service Sanitation) and Tooele County Health Department Regulation #4. This permit is revocable for noncompliance.
****Permit is valid for inclusive dates listed above only****

AT LEAST ONE PERSON MUST BE PRESENT AT ALL TIMES THAT HAS A VALID FOOD HANDLER'S PERMIT
AVAILABLE UPON REQUEST BY THE LOCAL HEALTH AUTHORITY.


I have read and understand
I have read and understand the Temporary Event Guidelines.
Signature of Applicant
Title
Date

Food Booth Worksheet

A site plan must be included with the worksheet. Plan should show locations of all cooking, cold and hot holding equipment, hand washing stations, scullery and garbage receptacles. Please email this plan to eh@tooelehealth.org.

Indicate how compliance with regulations will be achieved:
List all food items that will be prepared prior to the event
Of the items to be served hot, which will be cooked prior to the event?
*Accurate food thermometers must be used to determine appropriate final cook temperatures have been met.
Once cooked, how will each cooked product be cooled?
Once cooled, how and where will each food product be stored?
How and where will products be reheated?
If transported to the event site, what equipment will be used to maintain hot food items?
*Must be kept at 135 degrees or greater.
How will hot food items be stored above 135 Degrees at the event site?
*List types of holding units and heat sources. If your booth requires electrical power, how will be it provided?
Of the menu items to be served cold, which will need to be cooked ahead of time and the cooled?
*List the date and time when each will be prepared?
How will each product be cooled?
How and where will each cold food product be stored prior to the event?
What equipment will be used to transport cold food at 41 F or below to the event site?
How will cold food items be stored below 41 Degrees F at the event site?
*Mechanical refrigeration or coolant material (dry ice, ice, gel packs, flue ice, etc.) must be provided.
List types of holding units, types of coolants to be used.
What final assembly of food products will take place at the event?
As foods are sold, how will product be re-supplied to the booth?
(Replenishing new product into old product is prohibited.)
How and where will utensils be washed, rinsed and sanitized?
Sanitizer to be used
Bleach
Quats
Concentraton of sanitizer - ppm
  (Note change every 2 hours)
Are test strips used?
Yes
No
Does your water come from an approved source according to LAW?
What will be used to wash hands? Describe set up?
How will waste water be collected?
How will waste water; such as wiping cloth water, hand wash water,
or water from cooking processes, be collected?
Where will wastewater be disposed?
How will garbage/trash be disposed?
 

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