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 Food Establishment Permit
Please put N/A for any fields that are not applicable
 
Establishment Name
Owner
Phone
Mailing Address
City/State/Zip
Email Address
Please Select one
 
Single Event Permit
Event Name
Event Location
Event Coordinator
Event Coordinator Phone
Booth Contact Person
Booth Contact Phone
Requested Permit Date (Begin)
Requested Permit Date (End)
Hours of operation
Number of Booths
 
Annual Permit
  • An annual food establishment permit will only be issued to vendor with a satisfactory history of food code compliance in Tooele County
  • A scheduled listing the dates and times of event must be submitted to the Department at the time of application. Any additions to the schedule must be submitted to the Department at least 72 hour prior to the event.  Failure to do so may result in the exclusion of the establishment from the event.  Schedule can be emailed to eh@tooeleco.gov.

Application and Permit Fee Schedule
Level of Hazardous Food
Choose only one - Tier 1, Tier 2, Annual
Tier 1 - Three or less 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
*Permit Fee Quantity - Per Booth/Per Day
Late Permit Fee-Less than 72 hours prior to event:   $35.00   Quantity:   Item Subtotal:  
$0.00
 
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
*Permit Fee Quantity - Per Booth/Per Day
Late Permit Fee-Less than 72 hours prior to event:   $55.00   Quantity:   Item Subtotal:  
$0.00
Annual Permit
*Permit Fee Quantity - Per Booth/Per Year
Annual Permit:   $200.00   Quantity:   Item Subtotal:  
$0.00
Total:
$0.00
 
Menu Items
 

A site plan must be included with this worksheet.  Plan should show locations of all cooking, cold and hot holding equipment, hand washing stations, scullery, and garbage receptacles.


Indicate how compliance with regulation will be achieved:
List all food items that will be prepared prior to the event
 
If food is prepared prior to the event, where will it be prepared?
Commissary Name
Address/City
Phone
 
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 it be provided?
 
Of the menu items to be served cold, which will need to be cooked ahead of time and the cooled?
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?
List types of holding unit, types of coolants to be used
*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
Concentration of sanitizer - ppm
                                  (Note change every 2 hours)
Are test strips used?
Yes
No
Source of water Hot
Source of water Cold
Source of water Tempered
 
What will be used to wash hands? Describe set up
 
How will wastewater, be collected?
wiping cloth water, hand wash water, or water from cooking processes
 
Where will wastewater be disposed?
 
How will garbage/trash be disposed?
 

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.

Statement: I hereby certify that all information provided is correct, and I fully understand that any deviation without approval from the Tooele County Health Department may be grounds for suspension of any permit issued. The health department can make additional requirements.

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

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