Get AZ Temporary Food Service Establishment Permit Application Form

GOV TEMPORARY FOOD SERVICE ESTABLISHMENT PERMIT APPLICATION FORM PLEASE COMPLETE RETURN THIS FORM WITH THE REQUIRED PERMIT FEE OF 85. APPROVAL OF THE APPLICATION WILL ONLY OCCUR AFTER ALL REQUIRED INFORMATION HAS BEEN SUBMITTED. ONLY THOSE VENDORS SELLING BOTTLED WATER OR CANNED SODA UNOPENED FROM AN APPROVED SOURCE NO ICE DISTRIBUTION ARE EXEMPT FROM OBTAINING A TEMPORARY FOOD SERVICE PERMIT. ALL OTHER VENDORS REGARDLESS OF PRODUCT ARE REQUIRED TO OBTAIN A PERMIT AND PAY THE ASSOCIATED PERMIT FEE. ADVANCED PREPARATION OF FOOD IN THE TEMPORARY FOOD SERVICE ESTABLISHMENT FOR MULTI - DAY SERVICE IS PROHIBITED. Menu Information 13 List full menu to be served at the event 14 Where will foods be purchased/obtained from 15 Will any foods be prepared prior to the start of the event If yes where will the food be prepared 16 If answering yes to questions 14 all foods prepared prior to the event are required to be made in an approved and permitted facility. A copy of the Food Establishment Permit and signed Commissary Agreement attached are required for approval of this application. Applications submitted without this information will be returned. Has a copy of the Food Establishment Permit and signed Commissary Agreement been included with this application N/A 17 Will frozen foods be thawed at the event If yes describe method/process to be used 18 How will any leftovers of cooked foods be handled at the end of each day no cooling of hot foods Equipment Information 19 How will food temperatures be monitored at the event 20 Describe equipment to be used at the event for a Cold holding b Hot holding c Cooking/Reheating 21 Describe handwashing facilities inside the temporary food service establishment booth Plumbed Sink OR Gravity Flow Set-up See Guideline manual 22 Describe utensil washing facilities at the event 3-Compartment Sink OR 3-Container Sanitizing Set-up See Guideline manual 23 How will hot water be made available for the handwash and utensil wash stations 24 What type of sanitizer will be used at the event Bleach Quaternary Ammonium Iodine 25 Describe booth construction to be used at the event Please indicate what material s will be used for flooring sidewalls and overhead protection. Note A current picture or drawing can be attached in lieu of answering this question. Additional Event Information 26 How will potable drinking water be obtained during the event 27 How will wastewater be disposed of water from utensil washing and handwash station 28 Do employees have current Maricopa County Food Handler Training If no do employees have food safety training from another state and/or county If yes from where 29 Does the owner or person in charge of the food service booth have Maricopa County Food Manager s Certification If no does this person have nationally recognized food manager certification from another state and/or county Proof of Lawful Presence in the United States Type of Identification to be verified circle one a Arizona driver license issued after 1996 or an Arizona non-operating identification license. b Driver license issued by a state that verifies lawful presence in the U.S. please note that driver licenses from the states of Hawaii Maine Maryland Illinois New Mexico Utah Texas and Washington will not be accepted. A copy of the Food Establishment Permit and signed Commissary Agreement attached are required for approval of this application. Applications submitted without this information will be returned. Has a copy of the Food Establishment Permit and signed Commissary Agreement been included with this application N/A 17 Will frozen foods be thawed at the event If yes describe method/process to be used 18 How will any leftovers of cooked foods be handled at the end of each day no cooling of hot foods Equipment Information 19 How will food temperatures be monitored at the event 20 Describe equipment to be used at the event for a Cold holding b Hot holding c Cooking/Reheating 21 Describe handwashing facilities inside the temporary food service establishment booth Plumbed Sink OR Gravity Flow Set-up See Guideline manual 22 Describe utensil washing facilities at the event 3-Compartment Sink OR 3-Container Sanitizing Set-up See Guideline manual 23 How will hot water be made available for the handwash and utensil wash stations 24 What type of sanitizer will be used at the event Bleach Quaternary Ammonium Iodine 25 Describe booth construction to be used at the event Please indicate what material s will be used for flooring sidewalls and overhead protection. Note A current picture or drawing can be attached in lieu of answering this question. Additional Event Information 26 How will potable drinking water be obtained during the event 27 How will wastewater be disposed of water from utensil washing and handwash station 28 Do employees have current Maricopa County Food Handler Training If no do employees have food safety training from another state and/or county If yes from where 29 Does the owner or person in charge of the food service booth have Maricopa County Food Manager s Certification If no does this person have nationally recognized food manager certification from another state and/or county Proof of Lawful Presence in the United States Type of Identification to be verified circle one a Arizona driver license issued after 1996 or an Arizona non-operating identification license. b Driver license issued by a state that verifies lawful presence in the U.S. please note that driver licenses from the states of Hawaii Maine Maryland Illinois New Mexico Utah Texas and Washington will not be accepted. c Birth certificate or delayed birth certificate issued in any state territory or possession of the U.S. d U.S. certificate of birth abroad. e U.S. passport. General Event Information 1 Name of Event 2 Date of Event 3 Time of Event 4 Location of Event Facility Name 5 Event Coordinator Name Address Phone Applicant Information Your Organization/Business Name Applicant s Name City State Zip 9 Business Phone Home Phone 10 Mobile Phone Fax 11 Email 12 Does this business have a current Mobile Food Pushcart Food Peddler or Catering permit from Maricopa County Yes No If yes what is the type of permit and permit number Note Vendors with these types of permits are not required to pay the permit fee for a Temporary Food Service Establishment. Menu Information 13 List full menu to be served at the event 14 Where will foods be purchased/obtained from 15 Will any foods be prepared prior to the start of the event If yes where will the food be prepared 16 If answering yes to questions 14 all foods prepared prior to the event are required to be made in an approved and permitted facility. A copy of the Food Establishment Permit and signed Commissary Agreement attached are required for approval of this application. Applications submitted without this information will be returned. Has a copy of the Food Establishment Permit and signed Commissary Agreement been included with this application N/A 17 Will frozen foods be thawed at the event If yes describe method/process to be used 18 How will any leftovers of cooked foods be handled at the end of each day no cooling of hot foods Equipment Information 19 How will food temperatures be monitored at the event 20 Describe equipment to be used at the event for a Cold holding b Hot holding c Cooking/Reheating 21 Describe handwashing facilities inside the temporary food service establishment booth Plumbed Sink OR Gravity Flow Set-up See Guideline manual 22 Describe utensil washing facilities at the event 3-Compartment Sink OR 3-Container Sanitizing Set-up See Guideline manual 23 How will hot water be made available for the handwash and utensil wash stations 24 What type of sanitizer will be used at the event Bleach Quaternary Ammonium Iodine 25 Describe booth construction to be used at the event Please indicate what material s will be used for flooring sidewalls and overhead protection. Note A current picture or drawing can be attached in lieu of answering this question. Additional Event Information 26 How will potable drinking water be obtained during the event 27 How will wastewater be disposed of water from utensil washing and handwash station 28 Do employees have current Maricopa County Food Handler Training If no do employees have food safety training from another state and/or county If yes from where 29 Does the owner or person in charge of the food service booth have Maricopa County Food Manager s Certification If no does this person have nationally recognized food manager certification from another state and/or county Proof of Lawful Presence in the United States Type of Identification to be verified circle one a Arizona driver license issued after 1996 or an Arizona non-operating identification license. .