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2019 Tff-organizer-application Fill-in

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1
Rev. 10/01/2019
CITY OF LONG BEACH
DEPARTMENT OF HEALTH & HUMAN SERVICES * BUREAU OF ENVIRONMENTAL HEALTH
2525 Grand Avenue, Room 220, Long Beach, Ca 90815 562-570-4132 Fax 562-570-4038
www.longbeach.gov/health/eh/food/tff.asp
COMMUNITY EVENT ORGANIZER PERMIT APPLICATION
**Applications must be submitted two weeks prior to the event**
Refer to the Temporary Food Facility (TFF) Guidelines for more information available online
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
ORGANIZER APPLICABLE FEES: Check the Appropriate Box
$ 99.00 → Non-Profit*
$ 195.00 → Profit
Organizer Type *Proof of Non Profit Status Will Be Required
$ 68.00
Late Fee (If Applicable)
Added to total amount, if the application is submitted less than 2 Weeks prior to the event date. NOTE:
Non-profit events are exempt from this fee
Total Amount Paid: **
**Fees are subject to change without notice
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Date of Application
EVENT INFORMATION
Name
Location
Date(s): Number of Days:
Date(s) Open
to the Public
Vendor Set-up Time
Times Open to
the Public
Expected
Attendance
Time Stop Serving:
If Event is at night, is adequate lighting
provided for the event:
YES NO N/A
EVENT ORGANIZER / PROMOTER INFORMATION
Name
Mailing
Info
Street # &
Name
City State
Zip
Code
Person(s) In Charge /
Contact Person(s)
Names
Person(s) In Charge /
Contact Person(s)
Phone Number(s):
Cell Phone
Alt Phone
Person(s) In Charge /
Contact Person(s)
e-mail:
All Temporary Food Facilities Must have a Bureau of Environmental Health Permit. Please see attach food vendor list.
TEMPORARY FOOD FACILITY BOOTHS
• Food preparation booths must be constructed with 4 sides, floor covering and overhead protection.
• Pre-packaged food booths must have floor covering and overhead protection.
• Indicate number of Food Facility Booths participating in the event
Pre-packaged - Prepackaged samples properly labeled, unopened packaged foods from a licensed manufacturer such as sodas, candy, chips, etc.
Pre-packaged with unpackaged samples -
Properly labeled, unopened packaged foods from a licensed manufacturer such as sodas, candy,
chips, etc.
Unpackaged - Open foods including hot dogs, soft serve ice cream, shaved ice, etc.
Hawkers - Roaming prepackaged food sales within the perimeter of the event.
SUBMIT
2
Rev. 10/01/2019
TEMPORARY FOOD FACILITY WAREWASHING SINKS
• One ware-washing sink may be shared by up to eight TFF’s if provided by the Event Organizer.
• Ware-washing sink must be within 50 feet of TFF’s, have overhead protection, and be inaccessible to the public.
• ***Event Organizer is required to have emergency contact information for liquid waste removal company
Ware-washing facilities provided by:
Event Organizer Food Facility Operator
Total number of three-compartment sinks to be
provided:
(1 three-compartment sink for every eight (8) food preparation booths)
Method of liquid waste removal:
Plumbed to the sewer line
Drained to a waste holding tank
Waste tank maintenance schedule:
times/day times/hour
Waste Tank Removal
Company
Information
***
Name:
Telephone #:
Address:
FOOD HANDLER TOILET FACILTIES
• One toilet is required per 15 food workers and must be located within 200 feet of all food facilities.
• Hand-washing facilities must be adjacent to toilet facilities.
Total Number of TFF, truck, and cart worker:
Number of toilets available:
Distance from TFF/Food Truck(s):
Number of hand-washing sinks:
(one hand-washing sink for every toilet)
How are hand-washing facilities supplied with warm & cold running water?
Approved plumbing system
Reservoir Tanks
PUBLIC TOILET FACILITIES
Number of attendees anticipated during peak hours of operation:
Number of toilets provided:
Number of hand-washing sinks
(at least 1 hand-washing sink for every 10 toilets with 1 ADA
toilet):
How are hand-washing facilities supplied with warm & cold running water?
Approved plumbing system
Reservoir Tanks
For multi-day events how often are toilets
serviced?
times/day
ANIMAL AREAS
• If animal areas will be available at the event, provide handwashing facilities equipped with: running water, soap and single-use paper towels
in permanently mounted dispensers at the exit to the animal area.
• Post signage at the handwashing facilities directing people exiting to wash their hands.
• Animal areas must be located at least 20 feet away from any TFF and should not upwind any TFF eating area.
Will there be any animal areas at the event? Yes No
If YES, specify: Petting zoo Pony rides Other (describe):
__________________________________ _________
Application Signature:
Date:
Permit #:
OFFICE USE ONLY
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signature
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3
Rev. 10/01/2019
DEPARTMENT USE ONLY
□ Approved □ Rejected Permit #: Date Mailed:
□ Non Profit Event Organizer Fee $ 99.00
□ Event Organizer Fee: $ 195.00
□ Late Fee Added: $ 68.00
(If Less Than 2 Weeks Prior To Event Add not applied to nonprofit organizer)
□ Copies of application $ 3.00
Total Amount Paid: $
Approved By: Date:
Comments/Notes:
4
Rev. 10/01/2019
CITY OF LONG BEACH
DEPARTMENT OF HEALTH AND HUMAN SERVICES
BUREAU OF ENVIRONMENTAL HEALTH
Consumer Protection Program
2525 Grand Avenue, Room 220, Long Beach, California 90815
Phone 562-570-4132 Fax 562-570-4038
Credit Card Authorization Form
Date:
Payment for Services Rendered:
□ Organizer □ Temporary Food Facility □ Farmers Market Temporary Food Facility
□ Mobile Special Event TFF □ Other:
Name on Credit
Card:
Name Of
Facility/Booth:
Name Of Event:
Type of Card:
□ Master Card □ Visa
(Please check one)
Account #:
Expiration Date:
Security Code:
Billing Address:
City, State, Zip
Phone Number:
Total Amount
Charged:
$
By signing this form you authorize, Long Beach Health Department, Bureau of Environmental Health,
to charge your credit card for the amount listed above
Signature:
Please email authorization form to claro.rufo@longbeach.gov
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signature
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6
Rev. 10/01/2019
COMMUNITY EVENT ORGANIZER RESPONSIBILITIES
Event Organizer Responsibilities:
• Complete and Event Organizer Application/Permit, including a master list of all food vendors (temporary food facilities and
carts) along with a site plan showing the proposed locations of all of the food vendors, restrooms, and all shared utensil
washing, hand-washing, and janitorial facilities.
• Two weeks prior to the event, submit to the Bureau of Environmental Health Services office a completed Community Event
Organizer Application, all participating TFS applications, and the appropriate fee for the Event Organizer Permit. A late fee of
$68.00 will be assessed for late application.
• Arrange to have potable water available and an approved wastewater disposal site.
• Consider electricity needs of the vendors.
• Ensure that each food vendor is storing and preparing all food in an approved booth/area at the event or in a facility with a
current health permit, and that each vendor is complying with all City of Long Beach Temporary Food Facility Operating
Requirements.
Permits Required:
An Event Organizer Application/Permit is required, as well as permits for each Temporary Food Booth prior to opening for business.
Fees: Subject to Change
For Profit:
Community Event Organizer Permit $195.00
Community Event Organizer Permit Late Fee (if less than two weeks prior to the event add) $ 68.00
Prepackaged Temporary Food Stand $ 80.00
Unpackaged Temporary Food Stand $ 150.00
Sampling Temporary Food Stand $ 110.00
Temporary Food Stand Late Fee (if less than 7 calendar days prior to the event add per booth) $ 51.00
Field Licensing Charge ($33.00 + $51.00 + applicable application fee from above) $ 84.00
Copies of Application $ 1.60
For Non-Profit:
Community Event Organizer Permit $ 99.00
Prepackaged Temporary Food Stand $ 55.00
Unpackaged Temporary Food Stand $ 71.00
Sampling Temporary Food Stand $ 38.00
Late Fees:
Vendors with multiple booths are subject to a late fee of $51.00 per booth if the application is not received on time. Individuals,
organizations, or groups, which do not obtain a health permit prior to the event, are subject to closure and a penalty not to exceed
three times the cost of the permit
.
Food Safety Requirements:
All food booths must comply with the Temporary Food Facility Operating Requirements set for by the City of Long Beach, Bureau of
Environmental Health.
THE COMMUNITY EVENT ORGANIZER IS RESPONSIBLE FOR THE MAINTENANCE AND PROPER OPERATION
OF ALLSHARED FACILITIES. THE COMMUNITY EVENT ORGANIZER IS ALSO RESPONSIBLE FOR ENSURING
THAT ALLTEMPORARY FOOD FACILITIES ARE IN COMPLIANCE WITH ALL APPLICABLE SECTIONS OF
CALIFORNIA HEALTH AND SAFETY CODES (CalCode).
For additional information contact Claro Rufo at 562-570-4142 or email: claro.rufo@longbeach.gov
Make Check Payable to: City of Long Beach
Department of Health and Human Services • Bureau of Environmental Health
2525 Grand Avenue, Room 220, Long Beach, CA 90815
SIGNATURE OF APPLICANT DATE
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signature
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7
Rev. 10/01/2019
SUBMIT A SITE PLAN WHICH INCLUDES THE FOLLOWING:
1. Location of all temporary food facilities, restrooms, and wastewater disposal.
2. Location of all toilets
Note:
□ One toilet facility must be provided for each 15 employees within 200 ft.,
from the booths.
□ An approved hand washing facility with soap and paper towel must be
adjacent to toilet provided.
□ A minimum of one (1) chemical or portable toilet with hand washing station
set-up (including single-use soap and paper towels) is required for every
250 people or portions thereof that attend your event.
□ One (1) out of every ten (10) portable restroom must be ADA accessible.
3. Location of all ware-washing sinks (3 compartment sink)
Note:
□ Food grade hoses are typically white and labeled “food grade.” Garden
type hoses are not acceptable.
□ A maximum of eight (8) booths may share one (1) three (3) compartment
utensil sink
□ Overhead protection is required for all 3- compartment sink.
4. Location of janitorial facilities.
Note: The site plan must be drawn to scale and according to the guidelines
listed in the Community Event Organizer section of the City Of Long Beach
Temporary Food Facilities guidelines.
Refer to the Temporary Food Facility (TFF) Guidelines for more information available online at
www.longbeach.gov/health/eh/food/tff.asp
8
Rev. 10/01/2019
COMMUNITY EVENT MAP
Please provide the distances between the vendors and the restroom, janitorial, and had wash facilities, as well as the distance to
any three-compartment sinks provided.
Food Vendor # is to correspond Restroom Facilities
with the numerated Food Vendor List Attached
Janitorial Facilities Hand-washing Station Three Compartment Sink(s)
Provided
V
R
J
H
W
S
9
Rev. 10/01/2019
FOOD VENDOR LIST
CODES:
V #: Identification Number For Mapping Purposes
Name Of Food Vendor: Food Vending Business
Contact Person: Person Responsible For Booth
Address: Mailing Address of Contact Person
Phone #: Phone Number of Contact Person
Type: Pre-Pkg. TFS (prepackaged food booth)
Un-Pkg. TFS (unpackaged food booth) (ex. Catering truck, cart, etc.)
V#
Name of
Food Vendor
Contact Person
Address
Phone #
Type
10
Rev. 10/01/2019
CITY OF LONG BEACH
DEPARTMENT OF HEALTH & HUMAN SERVICES
BUREAU OF ENVIRONMENTAL HEALTH
2525 Grand Avenue, Room 220, Long Beach CA 90815
562-570-4132
ATTENTION NON-PROFIT EVENT OPERATORS
NEW POLICY REGARDING SPECIAL EVENTS FOR NON-PROFITS
DID YOU KNOW…
Non –profit organizations get discounted special event food permits
Non-profit organizers get three free temporary food booth permits for each event.
Late fees and field licensing fees are waived for non-profit organizations.
Free training is provided for all organizers and food booth operators on the first Thursday of every month at 3:00-
5:00 p.m. at 3820 Cherry Avenue, Long Beach, CA 90807. Contact: Claro Rufo at 562-570-4142.
When attending our free training, you are eligible for a discount on your special event food permit fee.
A special event facilitator is available to assist you in completing and obtaining your special event food permits.
Food safety materials are available online at www.longbeach.gov/health/eh/food/tff/asp
Special Event Organizer and Temporary Food Stand Permit applications are available online at
www.longbeach.gov/health/eh/food/tff.asp
If your event is less than 4 hours in duration, including setup, and you are serving certain foods, you may not need a special
event food permit. For more information contact Claro Rufo at 562-570-4142 or Jackie Hampton at 562-570-4132.
If you are a for profit organization donating 100% of your food proceeds to a non-profit organization, and you complete certain health department
forms, you do not need a special event food permit.
Documentation Acceptable as Proof Of Non-Profit Status
Document
Source
1. Article of Incorporation as a nonprofit organization Secretary of State
2. IRS letter showing organization to be Tax Exempt Internal Revenue Service
3. State Franchise Tax Board letter showing organization Tax Exempt Franchise Tax Board
4. Certificate of Registration with the State Registry of Charitable Trusts State Registry of Charitable Funds
5. Statement of Accountability A statement from the nonprofit
organization stating how the funds are
disbursed and amount of overhead
expenses
Documents may be faxed to 562-570-4038 or email Claro.Rufo@longbeach.gov
11
Rev. 10/01/2019
Food Preparation
TEMPORARY HAND WASHING
REQUIRED AT EACH
F
F
F
O
O
O
O
O
O
D
D
D
P
P
P
R
R
R
E
E
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P
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A
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I
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I
O
O
O
N
N
N
,
,
,
O
O
O
P
P
P
E
E
E
N
N
N
F
F
F
O
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O
D
D
D
S
S
S
A
A
A
M
M
M
P
P
P
L
L
L
I
I
I
N
N
N
G
G
G
&
&
&
B
B
B
E
E
E
E
E
E
R
R
R
/
/
/
S
S
S
P
P
P
I
I
I
R
R
R
I
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I
T
T
T
S
S
S
BOOTH
The temporary hand washing
station shall consist of at least a
5-gallon insulated container with
hands free spigot that provides a
continuous flow of warm potable
REV 10/01/2019
CITY OF LONG BEACH
DEPARTMENT OF HEALTH & HUMAN SERVICES * BUREAU OF ENVIRONMENTAL HEALTH
FOOD PROGRAM
2525 Grand Avenue, Room 220, Long Beach CA 90815
562-570-4132 Fax 562-570-4038
Email: Claro.Rufo@longbeach.gov
T EMPORARY F OOD F ACILITY P ERMIT APPLICATION
Refer to the Temporary Food Facility (TFF) Guidelines for more information available online
SPECIAL EVENT INFORMATION
Date of
Application:
Date Of
Event:
Name Of Event:
Location Of Event:
Time(s) Of Event:
Number Of
Days:
Name Of Event
Organizer
/Promoter:
TEMPORARY FOOD FACILITY OPERATOR INFORMATION
Name of Food
Facility / Booth:
Facility Operator
Name:
Driver’s
License #:
Mailing Address:
Telephone #: Message #:
Email:
# of Food
Employees:
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
TFS APPLICABLE FEES: Check the Appropriate Box
Non- Profit
with 501-C
Profit
Temporary Food Facility Type
$ 38.00
$ 77.00
Pre-packaged or Prepackaged samples
Includes prepackaged samples properly labeled, unopened packaged foods from a licensed manufacturer such as sodas,
candy, chips, etc Includes samples of pre-packaged perishable foods properly labeled, unopened packaged from a licensed
manufacturer such as yogurt, milk, etc.
$ 55.00
$ 110.00
Pre-packaged w/unpackaged samples
Properly labeled, unopened packaged foods from a licensed manufacturer such as sodas, candy, chips, etc., also selling and
giving opened samples.
$ 71.00
$ 150.00
Unpackaged
Open foods including hot dogs, soft serve ice cream, shaved ice, beer, alcohol, etc.
$ 28.65
Hawkers
Roaming prepackaged food sales within the perimeter of the event
$ 51.00
Late Submittal Penalty Fee
If less than 7 calendar days prior to event add per booth
$ 33.00+
$ 51.00
Field Licensing Fee
Applicable application fee from above
20% discount: $ - _________
Temporary Food Facility Training Certificate
Total Amount Paid:
*Fees are subject to change without notice
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
I have read and understand the requirement a noted on the City Of Long Beach Health Department, Bureau of Environmental Health, Food Program Temporary Food
Facility (TFF) Guidelines. I understand that it is my responsibility to meet all the applicable requirements during all hours of operation; failure to meet these
requirements can result in either a suspension of the TFF Health Permit, a penalty or an Office Hearing.
Signature Of Applicant:
Date:
FOR OFFICE USE ONLY
□ Approved
□ Rejected
Permit #
Mailed:
Permit Restrictions / Reason For Rejection
REV 10/01/2019
FOOD PREPARATION AT OTHER LOCATION
All food preparation must be completed either in the approved temporary facility or at a permitted food facility. Identify and facility where advanced
preparation will take place. An agreement form must be submitted for food preparation at a permitted food facility
Name of Facility:
Permit #:
Address of
Facility:
Method of food temperature control used during transportation:
EQUIPMENT/UTENSIL USED
Will multi-use kitchen utensils (knives, scoops, spatulas, bowls, etc.) be used inside the booth for food
preparation?
□ Yes
□ No
Identify all equipment that will be used in food preparation at the food both: □ Barbecue Grill □ Range Burner □ Deep Fryer
□ Griddle □ Char-broiler □ Mixer □ Blender □ Other
(Specify):
Identify all utensils that will be used in food preparation at the food booth:
Multi-use eating and drinking utensils are prohibited (plates, glassware, etc.)
As a vendor you are required to comply with the City’s new ordinance 8.63.010 which prohibits the use of single-use
food and beverage containers made of Polystyrene (EPS) foam rigid Polystyrene (plastic#6) and non-compostable/non-
recyclable materials for serving prepared food for immediate or to go consumption.
FOOD TO BE SOLD/SERVED
All food preparation shall be completed either in the temporary food facility or at a permitted food facility
List food items to be
sold/served:
(teriyaki chicken, tacos, salsa,
condiments etc.,)
Check if
commercially pre-
packaged:
(un-opened, original
containers)
Identify types of
preparation at
other location:
(cutting, washing, cooking,
etc.,)
Identify types of
preparation at
booth:
(assembly, portioning,
cooking, etc.)
Identify means of
temperature
control at booth:
(steam table, refrigerator,
ice chests, etc.,)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
14
Rev. 10/01/2019
City Of Long Beach • Department Of Health & Human Services • Bureau Of Environmental Health
TEMPORARY FOOD FACILITY SELF CHECKLIST
HEALTH PERMIT MUST BE PROMINENTLY DISPLAYED ON BOOTH
All items must be completed prior to serving food to the public
Food Booth Construction
Open or Non-prepackaged foods
Booth is entirely enclosed with all four complete sides, ceiling, and a floor
Floor is smooth and cleanable. Plywood, tarp, pavement, and asphalt is acceptable
Walls enclosures may be constructed of 16 mesh per square inch screen
Pass through window or door to access adjoining BBQ area
Food pass through openings 18” high x 24” wide maximum
Signage (visible to the public/can be posted at the front of booth) must include the following:
o Facility and Operator Name at least 3” in height.
o Facility City, State, and Zip Code at least 1” in height
o The above information shall be printed in colors contrasting with the surface on which it is posted
Trash container with lids.
For Prepackaged Food
Booth with overhead protection only
No specific flooring material requirements.
Food Preparation
Food stored at least 6” off the ground
All food contact surfaces are smooth, easily cleanable, and nonabsorbent
Food Handling
□ Food prepared or stored in a private residence is prohibited
□ All food preparation shall take place within an approved food facility or food booth
□ Food handlers shall follow proper hand washing practices, wear clean clothes, properly restrain hair and be in good health.
□ Bare hand contact with ready to eat food is minimized. Serving utensils, disposable plastic gloves, or tissues are used to prevent
Temperature Control
Adequate cold storage (ice chests with ice, refrigerated trucks or refrigerators)
Cold food must be maintained at 45° F or below. If ice is used to hold cold food, surround/cover food with ice.
Adequate hot storage (steam tables, chafing dishes, electric stove, heat lamps, and crock pots)
Hot food must be maintained at 135°F or above.
A calibrated metal, probe thermometer to measure food temperature must be available in the booth
ANY FOOD NOT MAINTAINED AT OR BELOW AT 41°F SHALL BE DISCARDED AT THE END OF THE DAY
Hand Washing Facilities
A container with a spigot or drain valve capable of providing a continuous flow of water that leaves both hands free to properly
wash
Minimum 5 gallon of warm water at minimum 100 °F.
Liquid soap in a pump dispenser
Single use paper towels
A bucket to collect wastewater
Trash receptacle
Utensil Washing Facilities
Access to a 3-compartment sink with integrally installed stainless steel drain boards with hot (100°F) and cold running water.
Soap for dish washing
Sanitizer for dish washing
Sanitizer test kit
Food Handlers
Clean outer garments for all food handlers
Hair of all food handlers is restrained with hairnets or hats
Provide adequate number of tongs, spoons, long handed forks, disposable gloves, or tissue
Food Protection
Condiments in containers with a hinged lid, squeeze bottle, pumps, or individual packets
Sneeze guards for steam table and open food
Ice used for refrigeration is not used for beverage consumption
Multi-Day or Night Events
Adequate lighting for cleaning and handling food
Lockable food containers for overnight storage
Refrigeration
COMPLETION OF THE CHECKLIST DOES NOT GUARANTEE COMPLIANCE WITH STATE LAW. THIS IS SOLELY INTENDED AS A
GUIDELINE FOR PROPER BOOTH SET UP
15
Rev. 10/01/2019
FOOD SAMPLING REQUIREMENTS
In an effort to increase sales of a food product or a piece of cooking equipment, samples of a food are sometimes given to the
consumer. Food is defined as any raw or processed substance, ice, beverage, including water, or ingredient intended to be used as
food, drink, confection or condiment for human.
1. A temporary food facility permit from the City of Long Beach is required when selling or giving away food to the public,
and/or when food samples are being given to the public. Permit must be displayed at booth for review during inspection.
2. A temporary hand washing station shall consist of at least 5-gallon insulated container with hands free spigot that
provides a continuous flow of warm potable water minimum of (100 F), liquid soap in a pump dispenser, single use paper
towels and a 5-gallon bucket to collect the dirty water.
This hand-wash station must be setup prior to preparing and handling food/food samples.
Minimum handwashing sink
3. Food samples must be protected from contamination, and where available for customer self-service, must be pre-
packaged, or available only from dispensing devices, or handed out individually by a booth employee to each customer. If
toothpicks are used in food samples, the toothpicks must already be inserted into food sample by booth operator to avoid
contamination of supply of toothpicks by customers.
Examples of dispensing devices include squeeze bottles and shaker bottles.
4. Food preparation (cutting, slicing, peeling, portioning, cooking, etc) of samples must be done at least 3 feet away from
customers to protect foods from contamination. Sneeze guards can be used to protect food from customer
contamination (i.e., sneezing, touching, hair, etc.).
5. Food Samples that are potentially hazardous foods (i.e., dairy products, meats, cooked foods, cut melons) must be kept
cold at or below 41° F or hot at or above 135° F.
6. All sampling utensil (i.e., cutting boards, knives, serving spoons, etc.) must be washed, rinsed and sanitized in a 3-
compartment sink every 4 hours. All food equipment and preparation surfaces must be smooth, easily cleanable,
and
nonabsorbent.
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Completed 13 July 2020

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