San Juan County Public Health
             
San Juan County Health Department
735 S 200 W STE 2, Blanding, UT, 84511
Phone (435) 587-3838
Application For Temporary Event Food Booth Permit

Type of Operation: Single Event (Good for any ONE event not to exceed 3 consecutive days)
or
Annual Permit (Good for all temporary food events in San Juan County for current calendar year)
Food Booth Owner
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Type of Business

Event Information

Please list all events you are planning on attending.
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
 
Event Name
Event Date
Location
Event Host
Phone Number
Booth Contact Person
Phone
Requested Permit Dates
First Date
Last Date
 

Food Preparation

Will all food be prepared at the service location?
Yes
No
If No, give the name and address of the approved commercial kitchen where food will be prepared:
Name of Approved Commissary
Address of Approved Commissary

List ALL prepared food menu items to be served (including prepared drinks, desserts, salads, etc.)

Menu Items

ADDITIONAL MENU ITEMS REQUIRE HEALTH DEPARTMENT APPROVAL!

How will food be kept COLD?
Ice chests
Onsite refrigerator
Onsite freezer
Other
How will food be kept HOT?
Cooked to order
Chafing dish/crock pot/roaster
Other

Food Safety

How will cleaning cloths be sanitized?
Sanitizing wipes
Bleach water solutioin (use test strips)
Other
How will hand washing facilities be provided to booth staff? Describe the setup:
How will waste water be collected?
How will waste water be disposed of? (Do NOT dump waste water on the ground or in the storm sewer)
How will garbage/trash be disposed? Is it provided by the event?
 

Terms and Conditions for Operating a Temporary Food Booth

  • A handwash station with soap , paper towels, and water is required to be set up for use prior to beginning any food preparation.
  • Bare hand contact with any ready-to-eat food items is not allowed.
  • All Time and Temperature Control for Safety (TCS) foods held cold shall be held at or below 41* F, including during transport. All TCS foods held hot should be held at or above 135* F at all times.
  • The booth must have at least one person present with proof of a valid food handler permit.
  • All garbage must be properly disposed.
  • All wastewater must be disposed to the public sewer system. Wastewater may not be discharged onto the ground, into storm drains, or waterways.
  • Potable water must be used for all booth operations.
  • All food or ingredients must be obtained from a commercial source.
  • All food must be prepared on-site, or at a permitted food establishment.
  • The permit to operate must be posted in public view.
  • I understand the following conditions will warrant immediate closure:
    • Lack of valid permit.
    • Lack of properly setup handwash station.
    • Foods prepared at or brought from home.
    • Imminent health hazards.
    • Lack of equipment or capacity to hold foods under proper temperature control.
BY SIGNING BELOW, YOU AGREE TO THE TERMS LISTED ABOVE.
Signature of Applicant
Title
Date
The Health Department Inspector will contact you shortly in response to your application. However, if you have any questions please call Dennis Shumway at 435-587-3838. Thank you!
Single Event Permit Fee:   $27.00   Select:   Item Subtotal:  
$0.00
2 Events:   $54.00   Select:   Item Subtotal:  
$0.00
3 Events:   $81.00   Select:   Item Subtotal:  
$0.00
Annual Permit Fee:   $86.00   Select:   Item Subtotal:  
$0.00
Total:
$0.00
Payment Information:
Processing Fee Rates:
Cards:2.5% ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:$0.75
Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Payment method will be collected on external device
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