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ON SHEET <br />Qn^'/T^ <br />Date <br />*« * <br />(Vfl ~w <br />TEMPORARY FOOD FACILITY ITFF) IN <br />Phone(Wilqqg- <br />Number of workers <br />k <br />1 <br />I have received a copy of the ‘'Temporary Food Facility Operating Requirements” including the <br />v Self-Inspection Checklist, and agree to follow these requirements. <br />I have included a site plan that indicates the proposed layout of equipment, food preparation <br /> tables, food storage, warewashing, and handwashing in my TFF. <br /></ I havp-^ft^hed a completed TFF menu sheet. <br />Signature <br />Title/Positi6n Sp/e <br />Environmental Management Department - 10590 Armstrong Av|nue. ste B, Mather. CA 95655 • PH: (916) 875-6440 Pax: ( 916) 875-8513 <br />www.emd.saccounty.net2 <br />Zoifo cztoud j P-mpg fer/vaL <br />z Date(s) of Event 2^ ~ TJo j 2O))c> <br />g/^ po6 <br />2nd Phone <br />3. What do you need to bring to set up a hand-wash station? <br />4. Dcuyou need to setjjp a warewash station? What do you need to bring to setupa ware-wash station? <br />5. At what temperature should cold foods bekept? ''■y' <br />6. At what temperature should hot foods be kept? <br />? Is it ok to make food at home prior to the event for serving from your food booth? <br />Initial <br />Name of Event <br />Location of Event <br />Name of Food Booth (TFF) g/6 PoG <br />TFF Person in Charge (PIC) gON) fy'jZ&Y Pho&F^ <br />Contact Phone for day of event j <br />Event Organizer F7 <br />Approximate number of meals to be served (CCO-4 <br />If event is longer than one day: <br />a Where will utensils be washed? (example: restaurant, church, on-site) <br />• Where will the extra food be stored at the end of the day? G^ST'^S <br />IMPORTANT NOTES <br />1. Contact your local fire jurisdiction regarding applicable fire code requirements for use of cooking <br />equipment. A list of phone numbers has been provided on page 17 of this packet. <br />2. Complete the “TFF Self-Inspection Checklist” before beginning to operate and keep it available for <br />inspector review. (See pages 4-5 of packet) <br /> <br />Complete the following questions: <br />What is the final cooking temperature for chicken? <br />__________________________________________ ____________ <br />2. Do you need to set up_ahand-wash station in your booth?