Tooele Health Department

Requested Permit Dates

First Date

Last Date

Time of Operation

Hours of operation

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Tooele County Health Department

151 N. Main Street, Suite 140 - Tooele, UT 84074

Phone (435) 277-2440 Fax (435)277-2444

www.tooelehealth.org

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:

Number of Booths Requested

Menu Items

Booth Contact Person

Phone

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 Quantity - Per Booth/Per Day

Permit Fee - 72 hours prior to event:

$20.00

Quantity:

Item Subtotal:

$0.00

Date	[1]
Date	[2]
Date	[3]
Date	[4]
Date	[5]
Date	[6]
Date	[7]
Date	[8]
Date	[9]
Date	[10]

*Permit Fee Quantity - Per Booth/Per Day

Late Permit Fee-Less than 72 hours prior to event:

$35.00

Quantity:

Item Subtotal:

$0.00

Date	[1]
Date	[2]
Date	[3]
Date	[4]
Date	[5]
Date	[6]
Date	[7]
Date	[8]
Date	[9]
Date	[10]

Tier 2- More than three foods that require time/temperature control for safety.

*Permit Fee Quantity - Per Booth/Per Day

Permit Fee - 72 hours prior to event:

$40.00

Quantity:

Item Subtotal:

$0.00

Date	[1]
Date	[2]
Date	[3]
Date	[4]
Date	[5]
Date	[6]
Date	[7]
Date	[8]
Date	[9]
Date	[10]

*Permit Fee Quantity - Per Booth/Per Day

Late Permit Fee-Less than 72 hours prior to event:

$55.00

Quantity:

Item Subtotal:

$0.00

Date	[1]
Date	[2]
Date	[3]
Date	[4]
Date	[5]
Date	[6]
Date	[7]
Date	[8]
Date	[9]
Date	[10]

Total:

$0.00

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.

Temporary Event Guidelines

I have read and understand

I have read and understand the Temporary Event Guidelines.

Signature of Applicant

Title

Date

Food Booth Worksheet

Click here to upload additional documents if needed.

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?

If you have additional documents to send, please email them to eh@tooeleco.gov.

'Please Select Method of Payment to Continue'

Event Name is required
Location is required
Event Coordinator is required
Phone Number is required
Organization Name: is required
Address: is required
City: is required
State/Province: is required
ZIP/Postal Code: is required
Phone: is required
Email: is required
Number of Booths Requested is required
Menu Items is required
Booth Contact Person is required
Phone is required
First Date is required
Last Date is required
Hours of operation is required
Commissary Name is required
Contact Name is required
Address/City is required
Phone is required
'I have read and understand' must be checked to submit
Signature of Applicant is required
Title is required
Date is required
List all food items that will be prepared prior to the event is required
Of the items to be served hot, which will be cooked prior to the event? is required
Once cooked, how will each cooked product be cooled? is required
Once cooled, how and where will each food product be stored? is required
How and where will products be reheated? is required
If transported to the event site, what equipment will be used to maintain hot food items? is required
How will hot food items be stored above 135 Degrees at the event site? is required
Of the menu items to be served cold, which will need to be cooked ahead of time and the cooled? is required
How will each product be cooled? is required
How and where will each cold food product be stored prior to the event? is required
What equipment will be used to transport cold food at 41 F or below to the event site? is required
How will cold food items be stored below 41 Degrees F at the event site? is required
What final assembly of food products will take place at the event? is required
As foods are sold, how will product be re-supplied to the booth? is required
How and where will utensils be washed, rinsed and sanitized? is required
Concentraton of sanitizer - ppm is required
Does your water come from an approved source according to LAW? is required
What will be used to wash hands? Describe set up? is required
How will waste water be collected? is required
Where will wastewater be disposed? is required
How will garbage/trash be disposed? is required


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