RANDOLPH COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES TEMPORARY FOOD SERVICE APPLICATION FOR TEMPORARY FOOD SERVICE PERMIT
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1 RANDOLPH COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICES TEMPORARY FOOD SERVICE APPLICATION FOR TEMPORARY FOOD SERVICE PERMIT (Name f Establishment) (Operatr) (Telephne number) (Event) (Lcatin) (Date & Time f Event) (Operatr Mailing Address) 1. MENU: List all fds and where they were purchased: 2. Will all fds be prepared at the temprary fd service bth? Yes N Fill ut Sectin B belw. Fill ut Sectin A & B belw. FOOD CANNOT BE PREPARED OR COOKED AT HOME. 3. List each fd item, and check each item in which a preparatin prcedure will ccur. SECTION A: At the apprved kitchen: Fd Thaw Cut/ Assemble Ck Cl Cld Hlding Reheat Ht Hlding Prtin Package SECTION B: At the bth: Fd Thaw Cut/ Assemble Ck Cld Hlding Reheat Ht Hlding Prtin Package 4. On the back f this page, draw a sketch f the bth.
2 Bth Sketch: 1. Draw in the lcatin and identify all equipment including handwashing facilities, dishwashing facilities, ranges, refrigeratrs, wrktables, fd and single service item strage, etc. 2. Describe flr, wall and ceiling surfaces: Nt fr prfit rganizatin (n cst, need cpy f tax exempt letter) One time event ($20) Annual/Mbil ($45) RANDOLPH COUNTY HEALTH DEPARTMENT COMMENTS: Apprved: (Permit Number) Disapprved fr fllwing reasns: Cpy and/r permit t Applicant In Persn Mailed (Envirnmental Health Specialist) (Date)
3 423 E. Lgan PO Bx 488 Mberly, MO Applicatins fr temprary fd permits must be received 7 days prir t the event. TEMPORARY FOOD SERVICE OPERATING RULES PERSONAL HYGIENE Wash yur hands ften. Wash with sap and warm water befre starting t wrk, and after using the tilet, smking, eating, sneezing, cughing, tuching yur face, between handling raw and cked fd, and handling garbage. A handwashing statin can be set up using a large drink therms f warm water, sap, paper twels, and a catch bucket (this is a requirement). In the event that it is nt pssible t set up a hand washing statin, wet wipes, r sme ther pre-mistened twlette must be available and used t wash hands. Wear clean clthes and a hair restraint. Keep lng hair under the hair restraint. Remve all jewelry. Handle fd if yu have a cld, diarrhea, r pen cuts r sres. Wear a bandage n yur hand. Cver it with a dispsable glve. Lick yur fingers r eat during fd preparatin. Smke in the bth Tuch yur scalp r face while preparing fd. Use a clth twel fr wiping hands. FOOD PREPARATION & SERVICE Prepare all fds in the bth r a Randlph Cunty Health Department apprved kitchen. Use nly fd and ice frm apprved surces.
4 Thaw under refrigeratin, in cld running water (70 F r belw), as part f the cking prcess, r in the micrwave when cking will fllw immediately. Wash all fruits and vegetables. Ck fds t the fllwing internal temperatures: Prk 155 F Grund Beef 155 F Pultry 165 F Other ptentially hazardus fds 145 F NOTE: Ptentially Hazardus Fds are thse fds that supprt the rapid grwth f bacteria. They include: meats beans sups seafd rice stews baked ptates sauces gravies ht dgs chili spaghetti pasta dishes hams egg cntaining dishes casserles dairy prducts cream filled pastries pasta salad ptat salad dressings batters sandwiches etc. Keep ptentially hazardus fd at 41 F r belw r 140 F r abve. Use a metal stem thermmeter, with a range f 0 F F, t measure temperatures f ht and cld fds. Use prechilled ingredients t make salads, sandwiches and ther cld fds. Ck and hld ptentially hazardus fd at 140 F r abve whenever pssible. Avid cking and reheating. Use suitable utensils r dispsable glves whenever preparing r serving fd. Use hme canned r prepared fds. Thaw ptentially hazardus fd at rm temperature. Hld ptentially hazardus fd at rm temperature. Save leftvers. Use crck-pts fr cking Tuch ready-t-eat fds with bare hands. FOOD STORAGE AND DISPLAY Prvide ht hlding equipment t keep ptentially hazardus fds ht.
5 Prvide insulated cntainers t maintain temperatures f ht and cld fd during transprt. Stre all fd at least 6 inches ff flr. Stre all fds in riginal r ther apprved cntainers. Cver fd t prtect it frm cntaminatin. Wrap r prvide sneeze guards fr displayed fd. Prvide individual packets r dispensed cndiments. Rpe ff r segregate barbecue areas frm custmers. Sprinkle ne r tw capfuls f bleach ver ice t prvide a chlrine residual f 10 ppm when string canned and bttled beverages in ice. Stre raw fds with r abve cked fds. Stre packaged fds in undrained ice. Use stern fr ht hlding f fd. Stre cntainers f fd & ice chests in the sun. USE HOME CANNED OR PREPARED FOODS. EQUIPMENT AND UTENSILS Stre dispensing utensils in the fd with the handle up, clean and dry r in a clean bleach water slutin f 100 ppm (1/2 tsp/qt.). Stre utensils cvered, inverted r in cleanable cntainers t prevent cntaminatin. Display single service utensils s handles are presented t the custmers. Prvide equipment capable f maintaining ht fds ht and cld fd cld. Use utensils and equipment in gd repair that can be easily cleaned. Use nly hard wd (maple, ak) r apprved plastic cutting bards. Stre equipment, utensils and single service items at least 6 inches ff the flr. Use enamelware r sft wd utensils. Reuse cans r plastic bags fr fd strage. Reuse single-service items. Use galvanized wire r racks fr barbecuing. CLEANING AND DISHWASHING Use three sinks t wash, rinse and sanitize all utensils Use large enugh sinks t cmpletely immerse yur utensils. Scrape siled utensils befre washing Wash with ht water and detergent in the first sink.
6 Rinse in clean ht water in the secnd sink. Change water ften t keep it clean. Sanitize using 50 ppm bleach water in the third sink (achieve by using 1 tsp. f bleach per galln f water). Leave utensils in the sanitizer fr at least 7 secnds. Air dry. Clean and sanitize cutting bards and utensils every 4 hurs. Wash, rinse, and sanitize cutting bards between cutting up raw and cked fds r different kinds f raw meats. Use wiping clths with sanitizer ( ppm) t regularly wipe wrk surfaces. Use chlrine test strips t check sanitizing cncentratins f wiping clth slutin and during dishwashing. Use a twel t dry utensils. Use detergent in wiping clth sanitizing slutin. Make yur sanitizers t strng r t weak. WATER AND WASTEWATER Prvide water frm an apprved surce. Wastewater shall be dispsed f thrugh an apprved sanitary sewage system. Wastewater hlding tank must be 15% larger than water supply tank. Dump wastewater nt the grund r in the street. Reuse cntainers that had ther prducts in them fr ptable water (drinkable water). GENERAL SANITATION Keep cleaning supplies away frm fd and single service items. Label all cleaning supplies, including spray bttles s they can be identified. Prvide garbage cntainers with lids bth inside and utside the bth and keep them clean. Keep the bth clean. Keep the flr clean and dry. Leave garbage in the bth vernight. Use r stre pesticides in the bth. Stre mps r ther cleaning tls with fd.
7 PREMISES Must have verhead prtectin. Must be fully enclsed if bth is perated mre than 1 day. Screening material that is at least (16) mesh-t-the-inch r plastic may be used fr the walls. The flr f the bth shuld be hard, smth and cnstructed f an easily cleanable surface. All fd preparatin, fd strage and service must be dne within this enclsed area. Allw animals where fd is prepared r served. Allw unauthrized persnnel in yur bth.
8 423 E. Lgan PO Bx 488 Mberly, MO LIABILITY WAIVER FOR TEMPORARY FOOD-SERVICE OPERATIONS I, representing (name) (rganizatin) have received, read and understand the Temprary Fd Service Operating Rules prvided by the Randlph Cunty Envirnmental Health Services. I agree t assure that all fd wrkers perating ur temprary fd stand r event will read and fllw these rules. (signature f applicant) (date)
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