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• <br />0 Alameda County Department of Environmental Health (ACDEH) 1131 Harbor Bay Parkway, Alameda CA 94502 <br />Temporary Food Facility (TFF) permit application to operate at community events in Alameda County - excluding Berkeley <br />California Health and Safety Code states a permit is required to sell or giveaway food to the public. Section 114381 <br />Requirements prior to receiving a TFF permit are listed below: <br />Submit this complete application to dehwebbilling@acgov.org . Pay all permit fees. ACDEH reviews the application for compliance with <br />CA Health and Safety Code. Your permit will be emailed to you. Post your permit at your Temporary Food Facility in public view. Penalty <br />fees will apply to any application submitted less than five (5) days prior to the event, and/or if information is requested and/or missing <br />from your application is and not submitted five (5) days prior to the event. <br />OFFICE USE ONLY <br />DATE REC PE CODE AMT PAID EV# APVD BY DATE <br />OWNER NAME <br />R owena Rono <br />DO YOU HAVE SPONSOR <br />If no, your application <br />APPROVAL TO PARTICIPATE, Yes <br />will not be reviewed <br />BUSINESS NAME <br />Row's Roll <br />SUBMIT ONE APPLICATION <br />INDICATE INDOOR OR <br />PER BOOTH. # of Booths 1 <br />OUTDOOR cudoor <br />NAME OF THE BOOTH <br />Row's Roll 2°F <br />EMAIL ADDRESS. THIS IS HOW WE WILL CONTACT YOU IF MORE <br />INFORMATION IS NEEDED. PRINT CLEARLY <br />Ronorowena@yahoo.com <br />BUSINESS ADDRESS WITH CITY STATE AND ZIP CODE <br />16201 S Harlan Rd Lathrop Ca 95330 <br />MAILING ADDRESS IF DIFFERENT FROM BUSINESS ADDRESS <br />869 Loon St Lathrop Ca 95330 <br />BUSINESS AND CELL PHONE. THIS IS HOW WE WILL CONTACT YOU IF <br />MORE INFORMATION IS NEEDED. PRINT CLEARLY <br />408 807 2326 <br />OFFICE USE ONLY <br />FA # <br />NAME OF THE EVENT <br />West Coast Makers <br />EVENT ADDRESS WITH CITY <br />Chabot College 25555 Hesperian Blvd, Hayward <br />START DATE END DATE <br />3/9 90 Days <br />START TIME END TIME <br />12p-6p <br />EVENT SPONSOR NAME <br />Tatiana Aguilar <br />CONTACT PHONE <br />510-708-2346 <br />SPONSOR EMAIL <br />westcoastmakers@gmail.com <br />IF YOU ARE PREPARING FOOD AT A TIME AND LOCATION OTHER THAN THE EVENT TIME AND LOCATION YOU ARE REQUIRED TO PROVIDE ONE <br />OF THE FOLLOWING DOCUMENTS WITH YOUR APPLICATION FOR REVIEW. FOOD CANNOT BE MADE AT HOME <br />Commercial Kitchen Agreement <br />If you are renting/borrowing/or have arranged for <br />designee of the commercial kitchen. <br />Your Environmental Health Permit If you are not <br />commercial kitchen space <br />renting kitchen space, <br />If you process and package <br />—The document on page #7 must be signed by the owner or owner's <br />but preparing food in your own food facility, provide a copy/picture. <br />your product for sale. <br />or make your own dairy products <br />State of California Processed Food Registration. <br />ACDEH Cottage Food Registration. <br />have a softserve machine State of California Milk and Dairy License. If you <br />HOW TO PAY THE FEE. FOR FEES, SEE FEE SCHEDULE <br />PAY IN PERSON OR BY MAIL SUBMIT YOUR APPLICATION <br />ON PAGE #6 <br />AND PAYMENT <br />Make check payable to "Alameda <br />YOUR ELECTRONIC INVOICE, <br />FORMS AT THIS LINK TO <br />OR <br />TO ALAMEDA COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH 1131 <br />County Department of Environmental Health." <br />USE THIS LINK https://cleh.acgov.org/billing-fees-permits.page? <br />HARBOR BAY PARKWAY, ALAMEDA CA 94502. <br />FOR ONLINE PAYMENT ONCE YOU HAVE RECEIVED <br />TO APPLY FOR PERMIT FEE EXEMPTION, REVIEW SEE IF YOU QUALIFY https://deh.acgov.org/operations/tff.page? <br />FOR BILLING ASSISTANCE CONTACT DEHWEBBILLING@ACGOV.ORG CALL 510-567-6858 <br />1