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La LaPaz County Health DepartmentEnvironmental Health Division www.lpchd.comA Healthy Environment is a Healthy Community 1112 Joshua Ave., Parker AZ 85344928-669-1100 Fax 928-669-6703Office hours are 7:00 am – 6:00 pm Monday - Thursday

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Table of Contents Topic PageRegulatory Bill of RightsApplication Process Notice

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Licensing Time Frames 51

La Paz County AZ Temporary Food Application Revised 8/28/2018

Operating Guidelines and Application for

Temporary Food Booths In La Paz County, AZ

NOTE: This is a Temporary Food (14 days or less) Application. If you will be set up longer than 14 days and need an Arizona Mobile or County Mobile Unit Application, please

go to www.lpchd.com and download the applications. You must have a complete and enclosed Mobile Food Unit to

qualify as an Arizona Mobile Food Unit.If you are doing a chili cookoff, or cooking competition,

please download the guidelines and application for “Food Challenge Event” on the Health Department website at

www.lpchd.com.

http://www.lpchd.com/

Definitions 6-9Temporary Food Establishment

Food EstablishmentFood HandlerMobile Food UnitPotentially Hazardous FoodPerson In Charge

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66667

Permit Types/Fees 7Temporary Food Requirements 8-12

Permitting Requirements 8Physical Facility 8-10Operations 10-11Food Protection 11-12Food WorkersFood Handler Class Schedule

1313

Checklist for Temporary Food Booths 14Application (Detach and Return) 15-19

Phone Numbers:Health Department 928-669-1100

(You will need a Permit to Operate a Food Establishment)The Town of Quartzsite 928-927-4333

(Business License is required)Quartzsite Fire Department 928-927-6556

(You must have approval to cook in your unit)Town of Parker 928-669-5247

(Business License is required)Colorado River Indian Tribes Reservation (CRIT) Health Department 928-669-6577

(You will need CRIT Food Permit to operate on the Reservation)

A.R.S. §11-1602: REGULATORY BILLS OF RIGHTSA. To ensure fair and open regulation by counties, a person:

1. Is eligible for reimbursement of fees and other expenses if the person prevails by adjudication on the merits against a county in a court proceeding regarding a county decision as provided in A.R.S. §12-348.

2. Is entitled to receive information and notice regarding inspections as provided in A.R.S. §11-1603. 3. Is entitled to have a county not base a licensing decision in whole or in part on licensing conditions or

requirements that are not specifically authorized as provided in A.R.S. §11-1604.4. May have a county approve or deny the person’s license, application within a predetermined period

of time as provided in A.R.S. §11-1605.5. Is entitled to receive written or electronic notice from a county on denial of a license application that:(A) Justifies the denial with references to the statute, ordinance, regulation, delegation agreement or

authorized substantive policy statements on which the denial is based as provided in A.R.S. §11-1605.

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(B) Explains the applicant’s right to appeal the denial as provided in A.R.S. §11-1605.6. Is entitled to receive information regarding the license application process at the time the person

obtains an application for a license as provided in A.R.S. §11-1606.7. May inspect all ordinances, regulations, and substantive policy statements of a county, including a

directory of documents, at the office of the county or on the county’s website, as provided in A.R.S. §11-1607.

8. Unless specifically authorized, may expect counties to avoid duplication of other laws that do not enhance regulatory clarity and to avoid dual permitting to the maximum extent practicable as provided in A.R.S. §11-1604.

9. May file a complaint with the Board of Supervisors concerning an ordinance, regulation or substantive policy statement that fails to comply with A.R.S. §11-1602.

10. As provided in A.R.S. §11-1604, is entitled to have a county not request or initiate discussions about waiving any of the rights prescribed in A.R.S. §11-1602.

NoticeA.R.S. §11-1604. Prohibited acts by county and employees; enforcement; notice

● A county shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule, ordinance, or delegation agreement. A general grant of authority does not constitute a basis for imposing a licensing requirement or condition unless the authority specifically authorizes the requirement or condition.

● Unless specifically authorized, a county shall avoid duplication of other laws that do not enhance regulatory clarity and shall avoid dual permitting to the maximum extent practicable.

● This section does not prohibit county flexibility to issue licenses or adopt ordinances or codes.

● A county shall not request or initiate discussions with a person about waiving that person’s rights.

● This section may be enforced in a private civil action and relief may be awarded against a county. The court may award reasonable attorney fees, damages and all fees associated with the license application to a party that prevails in an action against a county for a violation of this section.

● A county employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action or dismissal pursuant to the county’s adopted personnel policy.

● This section does not abrogate the immunity provided by Section 12-820.01 or 12-820.02.

ARS §11-1606 Application Process Noticefor Temporary Food Establishment Permits

Under ARS §11-1606, La Paz County is required to give you certain information when you apply for a food establishment permit – steps required for permit approval, licensing times frames, and point of contact if you have questions.

The following steps are required in to obtain a Temporary Food Establishment permit to operate:

1. Obtain a copy of the “Operating Guidelines for Temporary Food Booths and Chili Cook Offs/ Cooking Challenges in La Paz County” and read thoroughly. If you have questions, contact the Health Department at 928-669-1100 and ask to speak to a Health Inspector. Your booth must meet the requirements of a Temporary Food Booth as outlined in the Guidelines and the Arizona Food Code. If, upon inspection, the inspector finds critical

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violations or noncompliance with building/temporary food guidelines, the temporary booth will be closed by the Health Department.

2. A Temporary Food Booth is limited to 14 days maximum at any one event.3. Fill out application “Temporary Food Application for La Paz County” completely.

Incomplete applications will delay permit approval or be denied. 4. Application must be submitted at least 15 days prior to event with the correct

review/permit fee. Review/permit fees are nonrefundable.5. The Health Department will review and contact you via some type of written

correspondence, either email or by letter with written approval and the operating permit OR a written list of concerns which must be addressed before approval can be issued.

6. If concerns are listed, provide required information and resubmit.7. Food handler cards are required. A copy of a food handler card from another jurisdiction

can be submitted with appropriate fee ($15.00) and a La Paz County Mobile Handler card will be issued. Otherwise, all food handlers and people working in Temporary booth must come to Health Department for Food Handler classes (offered Monday, Wednesday, and Thursday from 7:00 am – 5:00 pm) and take the test. Proof of Licensing Eligibility is required per AZ ARS 41-1080.

8. Business Permits are required through the Town of Quartzsite and Town of Parker. Please contact the towns to obtain an application to operate a business.

9. Approval from the Quartzsite Fire Department may be required when operating in Quartzsite. Please contact the Fire Department for more information.

-If a reinspection is required during any part of the permitting or inspecting process, a reinspection fee of $100.00 will be assessed.-If denied during any part of the permitting process, an appeal of the decision can be requested by written request to: Director, Environmental Health Division, 1112 Joshua Ave., 206, Parker, AZ 85344.- If application is not received at least 15 days before event, a $50 Late Fee will be assessed and must be paid before a permit is issued.

Applicable Licensing Time Frames (in days) Time frames can be found in the Arizona Administrative Code, R9-8-

104

Type of Approval Statutory Authority

Overall Time-Frame

AdministrativeCompleteness

Review

SubstantiveReview

FOOD ESTABLISHMENT LICENSE

ARS 36-136(H)(4)

60 30 30

Approval of Plans and Specifications under Food Code 8-201.11

ARS 36-136 (H)(4)

90 30 60

Approval of HACCP PLAN and Food Code 8-201.13

ARS 36-136(H)(4)

90 30 60

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Approval of Quality Assurance Program

ARS 36-136(H)(4)

90 30 60

Name/telephone number of a person who can answer questions or provide assistance during the application process: Environmental Health Staff at 928-669-1100

If you are unable to receive assistance from an inspector, you may contact the Environmental Health Director at (928)669-1100.

Under ARS §11-1609, you may request that the County clarify its interpretation or application of a statute, ordinance, regulation, delegation agreement or authorized substantive policy statement that affects the issuance of your food establishment permit by providing the County with a written request that states:

1. Your name and address;2. The statute, ordinance, regulation, delegation agreement or authorized substantive policy statement that requires clarification; 3. Any facts relevant to the requested ruling; 4. Your proposed interpretation of the applicable statute, ordinance, regulation, delegation agreement or authorized substantive policy statement or part of the statute, ordinance, regulation, delegation agreement or authorized substantive policy statement that requires clarification; 5. Whether, to the best of your knowledge, the issues or related issues are being considered by the County in connection with an existing license or license application.

DefinitionsArizona Food Code – food establishments in Arizona are regulated under the Arizona Food Code. It is available from the La Paz County Health Department or online at www.azdhs.gov/phs/oeh/. Additional requirements for food establishments are under the Arizona Administrative Code, Title 9, Chapter 8.

Temporary Food Establishment is a food establishment that operates for a period of no more than 14 consecutive days in conjunction with a single event or celebration (Arizona Food Code) such as fair, carnival, circus, public exhibition, or similar transitory gathering. A Permit to Operate must be obtained from the Health Department prior to the event. Food prepared or cooked in a private residence or an unpermitted facility is NOT allowed under any circumstances.

Cook-off/Cooking Challenge means a cooking or food preparation contest in which participants prepare food, usually using their own recipes, held as a public event with the food for sale or given away to the public (for example – chili cook-offs, salsa challenges, BBQ challenges, etc). Please obtain the Guidelines and Application for a Food Challenge at www.lpchd.com. A Food Service Permit IS REQUIRED.

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http://www.lpchd.com/

http://www.azdhs.gov/phs/oeh/

Food is any raw, cooked, or processed edible substance, or ingredients used or intended for use or for sale in whole or in part for human consumption, including ice, water, beverages, candy, and chewing gum.

Food Establishment – is an operation that stores, prepares, packages, serves, vends, or otherwise provides food for human consumption; whether for charge or free; whether permanent, temporary, or mobile; whether consumption is on or off the premises.

Food Handler means any person who handles, prepares, serves, sells, or gives away food for consumption by persons other than his or her immediate family, and who handles utensils or food equipment.A Food Handler Card from La Paz County is required to work in a temporary food booth.

Mobile Food Unit refers to an enclosed vehicle-mounted, boat-mounted, or trailer-mounted food establishment, designated to be readily movable from which food is cooked, processed or prepared and from which food is vended, sold, or given away. A Mobile Food Unit will receive an annual permit to be renewed yearly on January 1.

Nonprofit Establishment means a nonprofit, charitable, or eleemosynary institution. The annual permit fee may be waived upon written request and proof of nonprofit status (La Paz County Health Regulation III).

Potentially Hazardous Foods is a food where bacteria grows rapidly and can cause a food borne illness. These foods include milk or milk products, ice cream, cheese, eggs, meat including luncheon meats and hot dogs, poultry, fish, hamburgers, tacos, hotdogs, spaghetti, and chili. Cooked rice, potatoes, and beans are also considered to be potentially hazardous.

Non-potentially Hazardous Foods are food with a low water content, less capable of supporting rapid growth of toxic bacteria. This type of food includes fruit pies, cookies, cereals, soft drinks, coffee, cotton candy, popcorn, and candy bars.Person In Charge (PIC) is required in all Temporary food booths. This is a person in the food booth during all hours of operation who has specialized knowledge of food safety and who has the authority to make decisions about the operation including decisions about food safety and food handler health and hygiene.

Temporary Permit Types/FeesNOTE: A permit is NOT required to sell pre-packaged, non-potentially hazardous food such as bottled water and candy bars. The items must be packaged at a permitted food establishment and meet all local, state, and federal requirements for food manufacture. Any sampling of product requires a Type 1 Food Permit – no exceptions. Type 1 Food Permit – Permit is $50 for a maximum of 14 days at any one event.Examples are fountain drinks, coffee, popcorn, hotdogs (no chili).● Only pre-packaged potentially hazardous foods are available or sold; and/or● The potentially hazardous foods served are commercially pre-packaged in an approved food processing facililty; and/or● The facility only has limited preparation of potentially hazardous foods and beverages; and/or

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● The facility provides sampling of pre-packaged products or sampling of fruit/vegetables; and/or● The facility only serves beverages.

Type 2 Food Permit – Permit is $50 PLUS $10 per day (including first day). For example a two day permit would be $70.00. There is a maximum of 14 days at any one event.Examples are hamburgers, deli sandwiches, turkey legs, cook and serve food (no holdover to next day)● The food prepared in the facility is from raw ingredients and requires minimal assembly; and/or● Hot or cold food prep in the facility is restricted to same day service; and/or● Foods requiring preparation in the facility are from approved processing facilities.

Type 3 Food Permit (see Note below) – Permit is $50 PLUS $15 per day. For example a one day permit would be $65.00. There is a maximum of 14 days at any one event.Examples are beef brisket, rice, beans – food that is cooked and then held for next day (or later) service● The facility prepares and holds hot or cold food for more than 12 hours before serving; and/or● The facility cooks and cools three or more foods during the food handling process; and/or● The facility prepares food for off-site service; and/or● The facility vacuum packs food; and/or● The facility serves a highly susceptible population NOTE: Type 3 Food Permit is not typically appropriate for most Temporary Food Units. Unit must have commercial grade equipment and facilities.

Temporary Food Booth Requirements■ Permitting Requirements1 Make sure you have the correct application “Temporary Food Application La Paz

County.” Fill out completely, including a drawing of booth showing all equipment and sinks. Answer all questions. If not applicable, write NA. Include all menu or list all food to be prepared and served. Failure to fill out and submit the application/supporting data/drawing/fee will result in delayed processing of the application and a delay in the approval of the permit and may even result in application being denied. Submit application at least 15 days before event or $50 late fee will be assessed.

2. Permit fees are NON-REFUNDABLE. 3. It is recommended that any organization considering a temporary food event as a

fundraiser to contact the Health Department at least six months in advance before finalizing plans in order to discuss the requirements needed for a fun, safe, and lawful event.

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Physical Facility1 Toilet Facilities. The operators of temporary events and cook-offs/cooking

challenges must provide public toilet facilities.

2 Booth Construction. Booths which handle ready-to-eat food must be fully enclosed with three sides, one ceiling, a type of flooring, and a service counter which is partially enclosed. A service counter must be staffed at all times and not provide entry of dust, bird/insect droppings, and other contaminants. This requirement may be waived if the food booth will operate for less than 4 hours. However, if there is dust, insects, birds present – the Health Department may require closure of the booth if contamination of the food and food prep surfaces occurs or appears to be imminent. The Permit to Operate must be posted at all times, clearly visible to customers and Health Department personnel.

Example of a Temporary Food Booth The Booth has three sides, flooring, ceiling, and service counter.

Basic Requirements:3 Sides w/ ScreeningFlooringCeilingFront Service counter

3 Floors –floors must be concrete, asphalt, dirt, or gravel. If dirt or gravel, the floor must

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be covered with mats, removable platforms, duckboards, or other suitable material that is effectively treated to control dust and mud and keep in good repair.

4 Overhead Protection - required of all food preparation, food/paper goods storage, and ware washing areas, and shall be made of wood, canvas, or other materials to protect the facility from precipitation, dust, bird/insect droppings, and other contaminants.

5 Openings, Doors, and Windows –all openings shall be protected against the entry of contaminants by use of 16 mesh to 1 inch screen or other effective means. This may be waived if flying insects, vermin, birds, or other pests are not present due to location, weather conditions, or other limiting factors. Please have screen available for use in the event of insects and pests

6 Handwashing Facilities.

Minimum handwashing facilities consist of warm running water, soap, individual paper towels, and a bucket to collect the dirty water. For example, an air pump thermos or jug of warm water with a push button or turn spout container is an acceptable method for obtaining warm, running water. Heat water to 100-120 ° F.

Water must be from an approved source

7 Dishwashing facilities. Equipment and utensils must be washed in three sinks. The process includes washing in hot soapy water, rinsing in hot water, sanitizing, and air drying. Sponsors of large events (such as a chili cook-off or salsa challenge) can provide a conveniently located, properly plumbed three-compartment sink with hot and cold running water for all contestants if located in an easily accessible area. An individual booth may also provide three buckets with an area for air drying for the dishwashing process.

Sanitizer Test Strips must be available in the booth to test the strength of the sanitizer.

Operations1 Temporary food establishments must be set up in conjunction with some type of

Special Event, a public event or celebration, and must meet all zoning, and building/fire codes of the jurisdiction.

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2 Temporary food vendors who use ice chests for cold holding, or noncommercial grills for cooking may only prepare and serve for a maximum of four hours per day.

3 Wiping cloths. A separate bucket of sanitizer must be present for storing wiping cloths to be used on table tops, counters, and so forth. For example, one capful of liquid bleach added to one gallon of cold water is acceptable. This must be changed frequently throughout the day. Sanitizer test strips must be available to test sanitizer bucket.

4 Refrigeration. Mechanical refrigeration is required for all temporary food booths operating for longer than four hours per day. Cold food must be kept at 41°F or below.

5 Cooking. All cooking of foods must be done at back of booth, away from the general public. When barbecuing or using a grill, the equipment must be separated (roped off) from the public by at least 4 feet to protect the public’s safety. There is to be no outside frying in deep fat fryers. Booths operating by cooking on a grill outside can not operate for longer than four hours per day.

6 Hot Holding. Electrical/propane/gas equipment is required for hot holding purposes. Booths without mechanical methods of hot holding may not operate longer than 4 hours per day. Crockpots, steam tables, or other hot holding devices are not to be used as a means for heating up food, they are only used for hot holding purposes. Food should be heated on grill or propane/electric stove to bring food to a temperature of at least 165° F within 30 minutes.

7 Thermometers. A metal-stem type thermometer must be available and used to check internal food temperatures. Thermometers must be able to measure from 0° - 220° F. A method of cleaning thermometers (alcohol swabs, bucket of sanitizer) must be readily available to wipe off thermometer. All cooling equipment must have thermometers inside to check internal unit of equipment.

8 Water. Potable, drinking water from an approved source must be provided for food prep, hand washing, ware washing, and cleaning. Hot water must be provided to handsinks, three bay sinks.

9 Liquid Waste. Liquid waste and gray water should not be dumped into streets, storm drain, or onto ground. Use containers to collect the dirty water and discard in a sanitary manner (example, in the public restrooms).

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Refuse. A refuse container with a tight-fitting lid should be readily available for garbage.

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A broom and dust pan should be available for sweeping the floor. Chemicals such as liquid bleach, detergents, and others must be stored in a separate area away from food preparation and storage areas.

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Critical Item Violations. All critical item violations must be corrected immediately or the unit must cease operation. All other violations must be corrected within the time frame determined by the Health Inspector and a re-inspection will take place. Re-inspection fees are $100.00 and payable upon the re-inspection date.

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Grease. Grease must be collected and properly disposed of at the event or other approved location. Grease can not be disposed of in sanitary sewer.

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Samples. The promoter or applicant must provide a written description of how samples will be handled for optimum food safety and the Health Department shall approve in writing prior to the event the procedures used by the Temporary Food Booth for providing samples to the consumer. All food sampling of products must be done in a sanitary manner. All food samples must be handed to the customer in the appropriate single-service dispenser (napkin, plastic ramekin, toothpick, etc).

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Customer self-service is prohibited. Each person who provides samples shall provide a plastic-lined, waste container for the disposal of used, single-service items and other waste products.

Food Protection1 Foods should typically be Type 1 or Type 2 with limited or minimal preparation. Foods

requiring extensive hand contact or multiple steps should not be prepared or served. Keep It Simple For Safety.

2 All food and beverages must be from an approved source (a processor that has been inspected and approved by FDA or USDA or other regulatory authority). It must be safe, unadulterated, and honestly presented with appropriate labeling.

3 Food prepared or cooked in a private home or unpermitted facility is prohibited. Food MUST be prepared onsite or in a permitted, regulated facility. Make sure your commissary is permitted if you are using another facility to prepare/cook/store food. A signed Commissary Agreement Appendix C must be submitted with application.

4 Meat must be from an approved Arizona Department of Agriculture or USDA source. No home slaughter of meat or wild game meat allowed.

5 Meat must be cooked according to Arizona Food Code 3-401.11 re time and temperature. Meat must be cooked fast and to proper temperature.

6 Labeling. All prepackaged food shall be labeled in accordance with FDA guidelines with product name, processor name, address and phone number of processor, weight and ingredients. This information must be in English.

7 Transport and Storage of Food. Food should be purchased locally (within 45 miles), on a daily basis, or transported in a refrigerated truck or other method of cold storage during transport and stored in an approved, permitted food establishment prior to event. Food can not be stored in a private residence prior to the event. Food stored prior to event must be stored in a permitted food establishment and a copy of a Commissary Agreement must be on file with the Health Department (Appendix C – available online).

8 Food on display must be covered, and the public not allowed to help themselves to open containers. Condiments, such as ketchup, mustard, coffee creamer, and sugar should be served in individual packets or squeeze containers. Any self-service must be from containers protected by sneeze guards.

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9 Bottles or cans of beverages kept in a bucket of ice must be stored so the caps are visible above the ice. These beverages must be served by a food handler and not for self-service to avoid customer contamination of ice or bottle/can.

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Food and paper products must be stored at least 6 inches above the ground and protected from rodents and other vermin, and the elements.

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All ready-to-eat food (those foods that will not be cooked again after it is touched by food handler) must be handled with utensils, tongs, deli paper OR the food handler must wear non-latex gloves.

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All prepared food must be thrown away at the end of the day in all temporary food booths. There is to be no cold holding of cooked/prepared food for use the next day.

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Ice that is consumed or contacts food shall be obtained only in chipped, crushed, or cubed form from an approved source. The ice shall be stored in single-use food grade plastic bags. The ice shall be held in the original bags for dispensing to avoid contamination.

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Do not use food processes where cooling will be involved. A temporary food booth is limited to simple food preparation with few steps.

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Avoid hot holding of foods. In order to minimize the possibility of foodborne illness, simplify food handling methods. For example, use canned gravy and heat it up rather than making gravy from scratch.

Food Workers1 Food Handler Cards. All individuals working in the booth must obtain a La Paz

County Food handler card before working in the booth. Food handler cards must be posted during all hours of operation. Proof of licensing eligibility is required before a food handler card will be issued.

FOOD HANDLER CLASSES Cost of an annual food card is $15.00

How to obtain a La Paz County Food Handler Card:

1. You can obtain a food handler card by coming into the Health Department office at 1112 Joshua Avenue in Parker, Arizona and watching the 40 minute video. A test will be given and the applicant must score 70% or higher. There are also classes

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given sometimes throughout the county. Follow us on Facebook to be notified of current classes:

https://www.facebook.com/LaPazCounty.HealthDepartment/2. If you have a current food handler card from another

jurisdiction or from a certified food safety education organization (example: ServSafe), you can present your current card and pay the $15.00 for county card.

3. If you have knowledge of food safety and the Arizona Food Code, you can take the test and pass by 70% and pay $15.00 for county card.

2 Person In Charge. There must be one person in the food booth during all

hours of operation who has specialized knowledge of food safety and who has the authority to make decisions about the operation including decisions about food safety and food handler health and hygiene. This is called the “Person in Charge.” This is required by the Arizona Food Code.

3 Disease. No person who is infected with a communicable disease, such as a cold, flu, or who has open sores or infected cuts on the hands shall work in a temporary food booth.

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https://www.facebook.com/LaPazCounty.HealthDepartment/

CHECKLIST FOR TEMPORARY FOOD BOOTHS

□ Obtain Guidelines for Temporary Food Booths□ Fill out Temporary Food Booth application and submit with fee with required information□ Obtain food and ice from approved sources□ Use separate coolers for raw meats, clean vegetables and ice used for beverages

SET UP OF BOOTH□ 3 Sides with Screening□ Ceiling□ Flooring□ Service Counter (Screening may be required)

HAND WASHING SET UP□ 5 gallon thermal container with a continuous flow spigot to provide warm (100°F - 120°F) running water□ Soap□ Paper Towels□ Discard bucket

OPERATING SET UP□ Bucket and bleach for sanitizing solution (one capful bleach to a gallon of water )□ Wiping cloths (keep cloth immersed in sanitizer water)□ Metal Probe Thermometer with range of 0° F to 220° F (calibrate prior to using)□ Non-latex gloves□ Serving spoons, spatulas, knives, tongs, ice scoop, etc. (change out every 4 hours)□ Smooth easily cleanable cutting boards□ Food grade plastic wrap for covering food□ Adequate hot and cold holding equipment; and cooking or re-heating equipment□ Source for fresh water and wastewater disposal□ Pallets, boxes or shelves for food storage□ Covered trash container(s)□ Operating permit is posted inside of booth for easy viewing by public and Health Department

DISHWASHING FACILITIES□ Warm water (110°F – 120°F) □ 3 containers for wash/rinse/sanitize method of cleaning and sanitizing ware

(containers should be large enough to fit largest pots/pans/utensils )□ Bleach for third bucket for sanitizing solution (one capful bleach to a gallon of water)

TEMPORARY BOOTH WORKERS□ Food worker screening for illness and hygiene□ Hair restraints (cap, hair net, or hair pulled back)□ Booth workers have current La Paz County Mobile Handler cards and the cards are posted inside of booth□ A Person In Charge is in the booth during all hours of operation

PLEASE FILL OUT AND RETURN PAGES 15-19Temporary Food Permit Application La Paz County AZ Revised 8/2018

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1112 Joshua Ave., 206, Parker, AZ 85344 928-669-1100 Fax 928-669-6703 [email protected] information must be submitted or application will be delayed/denied Application must be submitted within 15 days of event or LATE FEE of $50 will be assessed.

1 Part 1 Temporary Food Booth InfoNote: A temporary food booth is allowed to operate only in conjunction with an advertised special event sanctioned

by town/county or community celebration for no longer than 14 consecutive days at any one event. 1a Name of Booth Hours per day of operation ___________

Operation start Date: Time: Operation end Date: Time:

1b Owner/Operator Name

Is the owner a Corporation or Nonprofit corporation? Yes No

1c Mailing Address ( Street, PO Box)

1d City/State/Zip

1e Phone NumberEmailFax Number

Note: Owner/Operator must provide Licensing Eligibility information and provide documentation with this submittal unless they are nonprofit or a corporation

2 Event Information 2a Name of Event

Date(s) of Event

Name of Person in Charge in Booth2b Location: Street: Town

2c Source of potable water

2d Public Toilet Facilities at EventCircle One: Permanent Flush Chemical Portajohns Other (describe)What type of handwashing facilities are provided for the toilets?

2e TYPE of Food Establishment (Check one)□ Type 1 Prepackaged or Limited Prep only $50 □ Type 1 Samples Only $50□ Type 2 Minimal Preparation (no hold over of foods until next day) $50 + $10 per day□ Type 3 Complex Food Preparation (hold over of food until next or later day) $50 + $15 per day

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3 Part 3 Menu/Food Transport, Storage, Preparation, Service3a Where will food be purchased and when?

Potentially Hazardous Food should be purchased locally unless transported in a refrigerated truck. Where will food be stored before event?Keep food receipts in booth for proof of purchase and proof of date of purchase

Food must be purchased immediately (same day) before event or stored in a permitted commissary prior to event. Complete Appendix C Commissary Agreement if storing in an offsite facility.Describe how frozen, cold, and hot foods will be transported to the event.

3b Will all foods be prepared at booth? Yes or No (Circle)If NO, complete Appendix C Commissary Agreement (attached) and attach a copy of current permit of facility if outside of La Paz County. Also complete Appendix D Food Prep at Commissary (attached).

# Note: Home/unpermitted facility prepared food IS NOT ALLOWED. All food must be stored, prepared onsite in booth or in a permitted food establishment and transported safely to event. No raw

or undercooked food allowed3c How will food temperatures be monitored during the event?

Will a temperature log be kept?

How many thermometers will be available and location:

3d Cold Holding Equipment Please explain your method of cold holding whether it is with mechanical equipment or ice chests (types and number of units, manufacturer name, etc.)

3e Hot Holding Equipment Please explain your method of hot holding (types and number of units, manufacturer name, etc)

3f Cooking Equipment Please explain your method of cooking whether through mechanical equipment or wood/charcoal sources (give types and number of units, manufacturer name, etc)

3g List a full menu of items to be prepared and served. Only food on list which has been approved by Health Department may be served.

Menu

3h Where will food/paper goods be stored during the event? Please show on drawing

3i Food Prep – List all Foods (use a separate page if necessary)Food Food

Source

ThawHow?

Where?

Cut/Wash/ Assemble

Where?

Cold Holding

How?

CookHow?

Where?

Cooling is not

allowed

Hot Holding

How?

ReheatingHow?

Where?

Handling

Tongs

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Where?Food Temp?

FoodTemp? Where? Food Temp?

Food temp?

Utensils, Gloves

4 Part 4 Booth Operation/Construction see Temporary Guidelines for construction requirements.

4a Booth will be set up and ready to inspect on:Date Time

# of hours of operation per day _______________# Note: Service counter at front of booth must be manned at all times if unscreened. Screening must be available for windows and openings OR the booth must be closed during dust storms or when insects/vermin are present.

Booth ConstructionPlease describe construction (3 walls, ceiling, floor, service counter, lighting, screening) and the materials (canvas, metal, wood, etc.)

Walls:

Ceiling:

Floor:

Manned Service Counter:

Lighting:

Are shields available for the lighting?

Screening available in the event of insects?

4b Provide a drawing of the temporary booth. Identify equipment, handwashing, warewashing, cleaning equipment, storage, work tables, condiment dispensing, customer self service area, garbage containers, service counter. – separate page can be used.

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4c Describe the utensil wash station and the procedure used to wash, rinse, sanitize, and air dry utensils and equipment.

4d A handwash station is required and a method of heating water for hot water is required.

Circle: Plumbed Sink OR Gravity Flow Set-Up (see Temp Guide)

43 How will hot water be made available to handwash sink and utensil wash station?

4f How will you dispose of gray water? It can not be thrown on ground or in street.

4g Will electricity be provided to your booth? Will it be provided 24 hours per day?

4h Sanitizer buckets are required with wiping cloths (Bleach at 50 ppm) Test strips must be available to test sanitizer.

Describe sanitizer bucket set-up (location and number of buckets)

4

4J

# of garbage disposal containers available in booth and outside of booth

Will you provide samples? If so, attach a separate page detailing how you will insure food safety with the sampling.

5 Submittal Requirements 5a A Complete Application must be submitted:5a.ii Fee or proof of nonprofit status must be included with each temporary submittal5a.iii Proof of licensing eligibility and required documentation must be submitted with all applications5a.iii Commissary or approved kitchen permit must be attached if required5a.iv Other documentation as required6 Owner agreement and signature

I have read the La Paz County AZ Temporary Food Vendor Guide and I understand that I must follow all of the requirements stated in the Guide as well as pertinent requirements of the Arizona Food Code.I understand that I must only prepare and serve food that was stated on my menu and approved by the Health Department and that all food is to be prepared and served from the temporary food booth unless a variance has been obtained from Health Dept.I understand that I must submit another application and get a permit from the Health Department if I change locations or have a second, satellite location.

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I understand that if anything changes concerning the information submitted in this application, I must notify the Health Department and get approval of revised circumstances before opening or continued operation.I understand that the Health Department can close my booth for a critical violation and charge a reopening inspection fee of $100.00.I understand that workers in the booth must obtain a La Paz County Health Department food handler card before working in my booth. Employees without a card will be asked to leave and a critical violation will be marked against the permit, requiring a reinspection and reinspection fee of $100 to be assessed.I agree to abide by the laws and regulations of the State of Arizona and La Paz County. I understand that retention of this permit is contingent upon satisfactory compliance with all state/ local lawsLicensing Eligibility Required per ARS 41-1080 >>Please attached a copy of identification – both sides of ID. Check the type of I. D. you will be submitting:□ AZ driver license issued after 1996 or AZ non-operating I.D. license□ A driver license issued by a state that verified lawful presence in U. S. (Licenses from HI, IL, ME, MD, NM, TX, UT, and WA are NOT acceptable)□ A birth certificate issued in any state, territory or possession of the U. S.□ A U.S. certificate of birth abroad □ A U. S. passport □ A foreign passport with U. S. visa□ A I-94 form with a photograph □ A U. S. certificate of naturalization □ A U. S. certificate of citizenship□ A U. S. citizenship and immigration service employment authorization document or refugee travel document□ A tribal certificate of Indian blood □ A tribal or Bureau of Indian Affairs affidavit of birth

By my signature below, I hereby certify, under penalty of perjury that the copy of the document I am providing is a true and accurate copy of the original document and that I am legally

authorized to be present in the United States. If further agree to operate under all requirements of the Arizona Food Code and La Paz County regulations as outlined in the

statements above.6a License Applicant Signature and date

Date

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