Northeast Tri County Health District Environmental Health Division Temporary Food Establishment Application Packet

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1 rtheast Tri County Health District Environmental Health Division Temporary Food Establishment Application Packet Always working for a safer and healthier Washington When is a Temporary Food Establishment Permit required? The Washington State Retail Food Code, Chapter Washington Administrative Code (WAC) requires that vendors, individuals or groups planning to hold or participate in an event, in which food will be served to the public, must obtain a temporary food service permit. rtheast Tri County Health District requires that a Temporary Food Establishment Permit must be obtained for each food booth in operation at an event. If you advertise your event with flyers, banners, newspaper ads or articles, internet, or by other means it is considered a public event, regardless of whether or not there is a charge for the food served. (Church dinners, or other events, that are only for members and their guests and are not advertised, are not considered to be public events.) Some foods are exempt from permit. Contact the Environmental Health office for more information about exempt requirements or visit our website at Temporary Food Establishments A temporary food establishment is defined as a food establishment operating at the same location, with the same menu, for not more than 21 consecutive days in conjunction with a single event or celebration, such as a fair or festival. or A food establishment operating not more than three days a week at the same location, with the same menu, in conjunction with an approved reoccurring, organized event, such as a farmers market or sport concession stand. Permit Categories & Fees Temporary food establishments are categorized based on the level of risk associated with the foods that will be served. Some foods can be prepared and served at a lower risk of foodborne illness than other foods. The category descriptions and fees are listed below. Fee Category Description $25.00* Low Risk Only low risk menu items appearing on the rtheast Tri County Health District Low Risk Food List may be served. Only commercially pre-cooked meats can be used; no raw meats. Some potentially hazardous foods (in bold on list) may only be held for service for 4 hours. $65.00* Moderate Risk Foods that are not on the low risk menu are served. Multiple Events $45.00* Reoccurring Low Risk $85.00* Reoccurring Moderate Risk Number of events X permit fee $30.00 Late Fee < 5 days Menu must be the same for all events. Only issued for Low & Moderate Risk Permits (not reoccurring) Either low risk or moderate risk permit conditions will apply. Issued for an approved reoccurring event, such as a farmers market. Must serve the same menu of foods. Must operate in the same location. Cannot operate more than 3 days per week. If the application is submitted less than five (5) days before the event, a late fee will be charged. Late fees are charged in addition to the permit fee. * n-profit organizations are allowed a 50% reduction on permit fees. Reduction does not apply to late fee.

2 n-profit/service Organization n-profit or service organizations may take a 50% reduction of the temporary food permit fee (not including late fees). n-profit or service organizations operating a temporary food establishment means a non-profit (recognized under section 501(c) of the federal Internal Revenue Code or registered through the Washington State Secretary of State as a charitable organization), a publicly funded or benevolent organization in which all individuals who staff the temporary food booth must be volunteers. Enforcement Fee Schedule At times, it becomes necessary to take enforcement action in order to protect public health. The descriptions and fees associated with enforcement actions that may apply to temporary food establishments are shown in the chart below. Fee Enforcement Action $ Operating without a permit $70.00 Follow-up Inspection $ nd Follow-up Inspection Description Fee will be charged if a permit is not obtained prior to the event. This fee is charged in addition to the permit fee and late application fee. Fee will be charged if a follow-up inspection is conducted. A follow-up inspection is conducted if red violations 25 points are observed during a routine inspection. Fee will be charged if a 2 nd follow-up inspection is conducted. A 2 nd follow-up inspection is conducted if red violations observed during a routine inspection are not corrected at the follow-up inspection. $ Re-Inspection Fee will be charged if a re-inspection is conducted. A re-inspection is conducted if red violations > 50 points, but < 75 points are observed during a routine inspection. $ Administrative Conference Fee will be charged if an administrative conference is conducted. An administrative conference will be conducted if red violations are not corrected at the time of a 2 nd follow-up inspection, or a reinspection, or if it is deemed necessary to address ongoing health hazards. Submit your completed application with the appropriate fee to one of the offices below. Please contact us if you have questions or need assistance in completing the application. Return your completed application with the appropriate fee to one of the below offices. Colville Environmental Newport Environmental Republic Environmental Address: 240 E. Dominion Colville, WA Address: 605 Hwy 20 Newport, WA Location: Mailing: 147 N. Clark PO Box Republic, WA Phone: (509) Phone: (509) Phone: (509) Fax: (509) Fax: (509) Fax: (509) Toll Free: Toll Free: Toll Free: Internet Internet Internet

3 rtheast Tri County Health District Low Risk Food List Food Item Blended drinks & drink mixes Caramel apples Cheesecake Cheeses & butter Chili & soup* Chocolate dipped fruit Churros Corn dogs * Deep fried Twinkies & candy bars Espresso coffee drinks Fish French fries Ham, bacon, sausage * Hamburgers * Hot dogs * Ice cream, milk shakes, & floats Iced drinks Lemonade & juices Meat Milk & Yogurt Nachos n-potentially hazardous baked goods Nuts Pancakes, waffles, funnel cakes Peanut butter and jelly, & grilled cheese sandwiches Pizza * Pretzels Poultry Sliced watermelon * Strawberry (or other berry) shortcakes Description Includes commercial mix with water from and approved source and commercially frozen fruit drinks, with ice from commercial source. Commercially prepared or made on-site by vendor Commercially prepared, with non-potentially hazardous toppings Processed from WSDA, USDA, or FDA facilities Commercially canned, ready to eat or condensed with water from an approved source. Does not include frozen or homemade soups Prepared on-site by vendor Baked on-site from commercially prepared, frozen dough, only non-potentially hazardous fillings may be used Commercially prepared, or hand-dipped from commercially prepared mix Commercially prepared, non-potentially hazardous snack cakes and candy bars, deep fried Hot or iced Commercially caught, processed in a state or federal facility, packaged, frozen Or other similar food, deep fried Commercially fully cooked (not raw), heated prior to serving Made from commercially fully cooked patties (not raw) Or hot dog like sausages, commercially pre-cooked, non-potentially hazardous toppings (condiments, onions, jalapenos) may be added Commercially prepared, hard of soft serve ice cream served in cones, bowls or cups. Milk or a carbonated beverage may be added. Including shaved ice, Italian Ice with milk, snow cones, served in single service cups or commercially made edible containers Commercially prepared, or fresh squeezed/prepared high acid beverages such as citrus, pineapple, cranberry, etc., Processed in a USDA facility, packaged, frozen And other commercially pasteurized, pre-packaged, single service dairy products Made with commercially canned cheese sauce and non-potentially hazardous toppings (onions, jalapenos) Breads, brownies, cookies, cakes, fruit pies baked in an approved food establishment. If baked on-site must be from commercially prepared products. With syrup flavorings, butter and/or shake-on toppings Made from commercial mixes, non-potentially hazardous fillings, toppings, condiments Made with commercially prepared products Made with commercially pre-cooked ingredients Prepared and baked on-site Processed in a USDA or WSDA facility, packaged, frozen Sliced Commercially prepared ingredients, canned whipped cream *Under low risk permit category, these potentially hazardous foods cannot be held for service longer than 4 hours. *

4 rtheast Tri County Health District Environmental Health Division Temporary Food Establishment Application Business/Organization Information Must complete Always working for a safer and healthier Washington Business/Organization Name: Address: City/State/Zip: Contact Person: Phone: Cell: Address: City/State/Zip: Send permit to: Business/Organization Contact Person Send via (pick one): Fax #: Mail Pick up by 4:00 PM Permit Category Low Risk Moderate Risk Permit Fee Description Only low risk foods from the rtheast Tri County Health District Low Risk Food List will be served. Complete Low Risk Information on $25.00 page 5. Serving foods that do not qualify for low risk. Complete Moderate Risk Information on page 6. $65.00 Multiple Events Reoccurring Low Risk Reoccurring Moderate Risk Late Application Permits for multiple events may be applied for on the same application if the menu will be the same for all events. Complete Event Information for all events. Only low risk foods from the rtheast Tri County Health District list will be served at a regularly occurring event, such as a Farmers Market. (same menu, same location, not more than 3 days a week) Complete Low Risk Information on page 5. Serving foods that do not qualify for low risk at a regularly occurring event, such as a Farmers Market. (same menu, same location, not more than 3 days a week) Complete Moderate Risk Information on page 6. Applications submitted less than 5 days before the event date will be charged a late application fee of $30.00 in addition to the permit fee. Total Fee n Profit 50% permit fee reduction n-profit organizations are allowed a 50% reduction on permit fees but reduction does not apply to late fee. $ Number of events X permit fee = $.00 $45.00 $85.00 $30.00 ***** FOR OFFICE USE ONLY ***** Permit Fee Date Received Receipt Number Permit Number Approved By Date Approved

5 Event Information Must complete for each event. Attach additional pages if needed Event Name: Event Location: Event Dates: Set Up Time: Time Food Served: from to Event Coordinator Name: Phone: Cell: Event Name: Event Location: Event Dates: Set Up Time: Time Food Served: from to Event Coordinator Name: Phone: Cell: Event Name: Event Location: Event Dates: Set Up Time: Time Food Served: from to Event Coordinator Name: Phone: Cell: Event Name: Event Location: Event Dates: Set Up Time: Time Food Served: from to Event Coordinator Name: Phone: Cell:

6 Facilities and Equipment Must complete 1. What type of kitchen facility will you be using? permanent kitchen booth 2. All water used must be provided from a public water system (city water, or a water system permitted by WA Department of Health). Where will water be provided from? 3. Waste water cannot be dumped down a storm drain or onto the ground. Where will waste water be disposed? 4. A handwashing station must be set up in the booth prior to any food preparation. What facilities will be used for handwashing? 5. Bare hand contact with ready to eat foods is prohibited. What will be used to prevent bare hand contact? 6. A metal stem, food thermometer, with a range of 0º F to 220º F, must be available to monitor food temperatures. If thin foods will be served, a tip sensitive, digital thermometer must be used. What type of thermometer will be available? 7. Foods must be stored in an approved location prior to the event. Where will foods be stored before the event? 7. Potentially hazardous foods must be kept at 41ºF or below during cold holding. What equipment will be used to keep foods cold? mobile unit (trailer) provided at event bottled other approved water system System name or ID number disposal provided by event other approved system plumbed sink gravity flow handwashing station gloves utensils deli tissue or napkins dial type thermometer digital thermometer commercial kitchen mobile unit (trailer) purchased day of event other cooler with ice refrigerators freezers 8. What equipment will be used to cook foods? fryer stove grill oven rice cooker BBQ other 9. Potentially hazardous foods must be kept at 135ºF or food warmer crock pot above during hot holding. What equipment will be used to stove grill hot hold foods? oven BBQ rice cooker other 10. What facilities will be available on-site for dishwashing? 3 compartment sink 2 compartment sink + 1 tub 11. An approved sanitizer must be available. Will a sanitizing solution (1 teaspoon bleach per gallon water) be available? 12. Restrooms, with a handwashing sink, must be provided for employee use. Describe the restroom facilities available and the location? 13. Garbage must be properly disposed of. How will garbage be disposed? 3 tubs other sanitizer disposal provided by event vendor will haul to dump

7 Person in Charge of Temporary Food Service Establishment There must be a Person in Charge on-site at all times with a valid Washington State Food & Beverage Worker Card. The person(s) in charge must have read rtheast Tri County Health District s Requirements to Operate a Temporary Food Establishment. Name: Expiration Date: Name: Expiration Date: Name: Expiration Date: Food & Beverage Worker Cards (or copy) must be available at the event location. I understand that it is the responsibility of the permit holder to comply with rtheast Tri County Health District s temporary food service regulations. I hereby certify that the above information is accurate and complete to the best of my knowledge. Coordinator/Owner Signature: Date: Return your completed application with the appropriate fee to one of the below offices or the application to ehmail@netchd.org. Fees for applications submitted via can be paid with a credit or debit card over the phone (a % card service fee + $ 0.15 transaction fee will be added to the fee amount). Call after submitting the application via to arrange for payment. Colville Environmental Newport Environmental Republic Environmental Address: 240 E. Dominion Colville, WA Address: 605 Hwy 20 Newport, WA Location: Mailing: 147 N. Clark PO Box Republic, WA Phone: (509) Phone: (509) Phone: (509) Fax: (509) Fax: (509) Fax: (509) Toll Free: Toll Free: Toll Free: Internet: Internet: Internet: ***** FOR OFFICE USE ONLY ***** Environmental Health Specialist s tes

8 Low Risk Information - Complete for Low Risk or Reoccurring Low Risk Permit Some foods can be prepared and served at a lower risk of food-borne illness than other foods. A Low Risk Permit will be issued if the following conditions are met: 1. Only commercially pre-cooked meats can be used; no raw meats. 2. Some potentially hazardous foods cannot be held for service longer than 4 hours. 3. Only foods from the list below may be served. 4. All foods must be from an approved source. Low Risk Menu Items - Please indicate what foods will be served. Blended drinks & drink mixes Caramel apples Cheesecake Cheeses & butter Chili & soup* Chocolate dipped fruit Churros Corn dogs * Deep fried Twinkies & candy bars Espresso coffee drinks Fish French fries Ham, bacon, sausage * Hamburgers * Hot dogs * Ice cream, milk shakes, & floats Iced drinks Lemonade & juices Meat Milk & Yogurt Nachos n-potentially hazardous baked goods Nuts Pancakes, waffles, funnel cakes Includes commercial mix with water from and approved source and commercially frozen fruit drinks, with ice from commercial source. Commercially prepared or made on-site by vendor Commercially prepared, with non-potentially hazardous toppings Processed from WSDA, USDA, or FDA facilities Commercially canned, ready to eat or condensed with water from an approved source. Does not include frozen or homemade soups Prepared on-site by vendor Baked on-site from commercially prepared, frozen dough, only non-potentially hazardous fillings may be used Commercially prepared, or hand-dipped from commercially prepared mix Commercially prepared, non-potentially hazardous snack cakes and candy bars, deep fried Hot or iced Commercially caught, processed in a state or federal facility, packaged, frozen Or other similar food, deep fried Commercially fully cooked (not raw), heated prior to serving Made from commercially fully cooked patties (not raw) Or hot dog like sausages, commercially pre-cooked, non-potentially hazardous toppings (condiments, onions, jalapenos) may be added Commercially prepared, hard of soft serve ice cream served in cones, bowls or cups. Milk or a carbonated beverage may be added. Including shaved ice, Italian Ice with milk, snow cones, served in single service cups or commercially made edible containers Commercially prepared, or fresh squeezed/prepared high acid beverages such as citrus, pineapple, cranberry, etc., Processed in a USDA facility, packaged, frozen And other commercially pasteurized, pre-packaged, single service dairy products Made with commercially canned cheese sauce and non-potentially hazardous toppings (onions, jalapenos) Breads, brownies, cookies, cakes, fruit pies baked in an approved food establishment. If baked on-site must be from commercially prepared products. With syrup flavorings, butter and/or shake-on toppings Made from commercial mixes, non-potentially hazardous fillings, toppings, condiments Peanut butter and jelly, & grilled Made with commercially prepared products cheese sandwiches Pizza * Made with commercially pre-cooked ingredients Pretzels Prepared and baked on-site Poultry Processed in a USDA or WSDA facility, packaged, frozen Sliced watermelon * Sliced Strawberry (or other berry) Commercially prepared ingredients, canned whipped cream shortcakes *Under low risk permit category, these potentially hazardous foods cannot be held for service longer than 4 hours. * *Will foods be prepared off-site? - complete off-site prep section on the next page

9 Moderate Risk Information - Menu of Foods Served List all foods and beverages that will be served. Food Item Supplier /Source Off-Site Prep (See below) Cold Holding Cooking Temperature Hot Holding How is food served? Off Site Preparation - This section must be completed if was checked in the Off Site Preparation column. Foods prepared off-site must be prepared at an approved kitchen. Name of Kitchen: Dates Kitchen will be used: Time: Kitchen Contact Person: Phone: Cell: