HomeMy WebLinkAboutTEMP EVENT OPERATORS AGRREEMENT FORM - 03-18Page 1 of 3
576-A
DES-210 (REV 3/18)
COMMUNITY EVENT TEMPORARY FOOD FACILITY
OPERATOR’S AGREEMENT FORM
Name of Event: ________________________________________________________________________
Location of Event: _____________________________________________________________________
Dates and Times of Event: _______________________________________________________________
Event Start Time: ______________________________________________________________________
Name of Food Facility: __________________________________________________________________
Name of Owner: _______________________________________________________________________
Name of Person in Charge: ______________________________________________________________
Check One: Booth Mobile Food Facility
If booth, describe enclosure: ______________________________________________________________
Food and beverage to be served: ___________________________________________________________
Where will food be prepared: _____________________________________________________________
How will food/beverage be prepared and served: ______________________________________________
List of cooking equipment: (Check all that apply)
Oven, # of units: Vertical Broiler, # of units:
Fryer, # of units: BBQ, # of units:
Flat grill, # of units: Stove or Range, # of units:
Other (please describe):
Fire extinguisher? Yes No (Check with city/county fire department for rating)
How will cooking equipment be ventilated? __________________________________________________
How will food be held hot (above 135˚F)? ___________________________________________________
How will food be held cold (below 45˚F)? ___________________________________________________
How will temperatures be monitored? _______________________________________________________
Describe hand wash setup:
Page 2 of 3
576-A
DES-210 (REV 3/18)
Describe utensil wash setup:
What type of sanitizer will you be using? Chlorine (100ppm, soak 30 seconds)
Quaternary Ammonia (200ppm, soak 60 seconds)
Do you have test strips to monitor the sanitizer concentration? Yes No
Will any food or equipment be stored outside of booth or mobile food facility? Yes No
If yes, how will food be dispensed, stored and protected; how will equipment be stored and protected?
I agree to adhere to the following requirements to operate at said event:
Name of facility, city, state, zip code, and name of the operator shall be legible and clearly visible to
patrons.
Hand washing facilities shall be provided at operations handling any open food. Hand washing facilities
shall be properly stocked and used as often as necessary to keep hands clean and protect food from cross-
contamination. Note: gloves and/or hand sanitizer are not approved replacements for hand washing.
All food and beverage items will be stored, displayed, prepared/ processed at an approved facility.
If applicable: Cottage Food Operation Name: ______________________________________________
Permit/ Registration Number: _______________________________________________
•Cold and hot holding equipment shall be provided to ensure proper temperature control during
transportation, storage, and operation of the temporary food facility.
•All potentially hazardous foods will be held at or below 45˚F or at or above 135˚F. At the end of the
operating day, any foods held above 41˚F shall be disposed of. Thermometers shall be provided to
monitor temperatures.
•Ice is considered a food and shall remain off the ground, stored in clean sanitized food grade containers
and properly dispensed by operator of the temporary food facility or in approved bulk dispensing unit(s).
•All equipment shall be maintained in a clean and sanitary condition.
•Equipment shall be washed in hot (minimum100˚F) soapy water, rinsed and sanitized either in a
3-compartment ware washing sink or 3-bucket system as approved by this department depending on
length of event. Sanitizer testing equipment shall be on-site to measure concentration of sanitizer.
•Operations handling any open food must provide completely enclosed booths. Contact this department
prior to event for approval of an alternative food protection means.
•Significant changes of menu items shall be discussed and approved by this Department prior to event.
Page 3 of 3
576-A
DES-210 (REV 3/18)
I understand these requirements and agree to operate in a manner to protect public health and food from
possible contamination.
Name: _______________________________________ Date: ____________________________________
Contact Phone Number Day of Event: ______________________________________________________
Email: _________________________________________________________________________________
PLEASE FAX TO AREA OFFICE PRIOR TO EVENT
Riverside Hemet Corona Murrieta Indio Palm Springs
(951)358-5017 (951)766-7874 (951)520-8319 (951)461-0245 (760)863-8303 (760)320-1470
For Office Use Only
Reviewed By: Date:
Notes: