Environmental Management
Department
Marie Woodin
, Director
11080 White Rock Road, Ste. 200 Rancho Cordova, California 95670 fax (916) 875-8513
Environmental Compliance (916) 875-8550 Environmental Health (916) 875-8440
www.saccoun
ty.net www.emd.saccounty.net
Mobile Food Facility Route Sheet
Name of Mobile Food Facility:
Lic plate #:
Name of operator:
Cell Phone#:
How will the refrigeration be powered on the mobile unit when it is operating away from the commissary? (i.e. generator, inverter, etc,.)
Please list your current route information/location of operation in the spaces provided below:
Days of Operation:
Start
End
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Time:
Time:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
NOTE: Additional agency approval may be required for the MFF operating locations (i.e code enforcement, zoning/planning).
If you are going to park your MFF at one location for longer than one hour, you must complete the Restroom Verification Form.
Revised route information may be provided by fax: (916) 875-8513, email: emdinfo@saccounty.net or US mail.
I understand and agree that if I make changes to my route or business location, I must notify the Environmental
Management Department (EMD) within 30 days.
Signed:
Title/Position:
Date:
E-mail:
Website:
OFFICE USE ONLY
Received/Reviewed by:
Date:
W:\Data\EH-PROGRAMS & PROJECTS\MFF AND TFF WORKING FOLDERS\MFFs\MFF FORMS & HANDOUTS (UPDATED)\WORD DOCS\OPERATOR - MFF ROUTE SHEET 3 4 15.docx
FA #
PR#