Fillable YOUTH SPORTING EVENT SNACK BAR HEALTH PERMIT APPLICATION (County of San Bernardino Information Services Dept.)

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YOUTH SPORTING EVENT SNACK BAR HEALTH PERMIT APPLICATION (County of San Bernardino Information Services Dept.)

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BROWSE COUNTY OF SAN BERNARDINO INFORMATION SERVICES DEPT. (CA) FORMS

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385 N. Arrowhead Ave., 2nd floor, San Bernardino, CA 92415
Email: EHS.CustomerService@dph.sbcounty.gov
Website: wp.sbcounty.gov/dph/ehs
Text/Call: 800.442.2283
Fax: 909.387.4323
07/2020 YSESB Health Permit Application Page 1 of 4
YOUTH SPORTING EVENT SNACK BAR HEALTH PERMIT APPLICATION
THIS SECTION TO BE COMPLETED BY APPLICANT • HEALTH PERMITS ARE NOT TRANSFERABLE
APPLICANT INFORMATION
Organization Name:
Contact Name:
Organization Address:
Contact Phone Number:
Email:
City:
State:
Zip:
DETAILS FOR SNACK BAR LOCATION ONLY
Name of Snack Bar:
Will you be operating more than one season? ☐ Yes ☐ No
Provide the dates for each season of operation for this year:
From To
From To
Address:
Hours Open to Public:
From
To
City:
Total Number of Operating Days:
Season 1
Season 2
☐
ATTACH A COPY OF GAME SCHEDULE TO APPLICATION
☐ INCLUDE HOURS OF OPERATION FOR EACH GAME DAY
☐
ATTACH COPY OF 501(C)(3) IF APPLICABLE
Days of Operation:
☐ Monday ☐ Tuesday ☐ Wednesday ☐ Thursday ☐ Friday
☐ Saturday ☐ Sunday
INVOICE INFORMATION
Mail To:
Attention To:
Address:
City:
State:
Zip:
MAKE CHECKS PAYABLE TO: SAN BERNARDINO COUNTY
This completed application, and all subsequent fees, must be submitted at least 2 weeks prior to the first date of operation. Failure to
complete the application and pay all fees will result in the assessment of a delinquent fee or closure. The YSESB will be held responsible
for any penalties. Health permits are non-transferable and must be posted in a visible place within the Snack Bar. The YSESB may only
operate at events approved by San Bernardino County Department of Public Health, Environmental Health Services (EHS).
Indemnification: The Contractor agrees to indemnify, defend (with counsel reasonably approved by County) and hold harmless the
County and its authorized officers, employees, agents and volunteers from any and all claims, actions, losses, damages, and/or liability
arising out of this contract from any cause whatsoever, including the acts, errors or omissions of any person and for any costs or
expenses incurred by the County on account of any claim except where such indemnification is prohibited by law. This indemnification
provision shall apply regardless of the existence or degree of fault of indemnities. The Contractor’s indemnification obligation applies to
the County’s “active” as well as “passive” negligence but does not apply to the County’s “sole negligence” or “willful misconduct” within
the meaning of Civil Code Section 2782.
I understand that the proposed type and frequency of operation will determine if this YSESB Health Permit
application can be approved. Plan submittal and review may be required for the YSESB to obtain a valid Health
Permit. The YSESB will be permitted to operate when the application has been approved and a valid health permits
has been issued.
Initials
For Office Use Only
Fee:
Record ID:
Program Identifier:
PE Number:
Late Fee:
☐
Y
☐
N
Designated Employee:
Received By:
Date:
Check One: ☐ New ☐ Transfer ☐ Reactivate
ID Number/Entity ID:
Changes (Please specify):
07/2020
YSESB Health Permit Application Page 2 of 4
SNACK BAR OPERATOR
SPECIFIC TYPE OF SNACK BAR PERMIT (SELECT ONLY ONE)
☐
Prepackaged
☐
Limited Preparation (i.e. heat and serve)
☐
Food Preparation
CERTIFICATIONS
Food Manager Certification:
☐
Yes
☐
No
☐
N/A
(
Not required for prepackaged facilities; required for snack bar
operating more than 25 days in a 90-day period).
San Bernardino County Food Handler Cards: ☐ Yes ☐ No ☐ N/A (Not required for prepackaged facilities; required for snack bar
operating less than 25 days in a 90-day period).
Volunteers are not required to obtain Food Handler Cards if the person in charge has a Food Handler Card or Food Manager
Certification. Volunteers are strongly encourage to take the Youth Sporting Events Food Safety Training online.
FACILITY DETAILS
☐
Temporary Booth
☐
Permanent Structure
☐
Other (Please describe): ______________________________
SNACK BAR OPERATION DETAILS
List the types of food/beverages that will be offered at the event.
Indicate source of foods offered (e.g. restaurant, wholesale club, supermarket, etc.) and describe how each type of food will be
handled/prepared.
SNACK BAR OPERATOR RESPONSIBILITIES
IT IS THE RESPONSIBILITY OF EACH SNACK BAR OPERATOR AT THE EVENT TO COMPLY WITH STATE AND LOCAL FOOD
SAFETY AND SANITARY REQUIREMENTS ENFORCED BY EHS.
CERTIFICATION STATEMENTS
PLEASE READ AND CERTIFY THE STATEMENTS ON THE FOLLOWING REGULATIONS BY INITIALING EACH SECTION BELOW.
FOOD SAFETY, STORAGE AND TRANSPORTATION
• With the exception of Cottage Food Operations, no home preparation or storage of food and beverage is allowed. All prepackaged
foods must be properly packaged and labeled at an approved facility
.
• During transportation, food must be protected from contamination and in approved containers capable of maintaining required
holding temperatures.
• Ensure all food, utensils and equipment are stored, displayed and served so they are protected from contamination. Food must
be stored off the floor, on appropriate shelving, boxes, or pallets.
• All potentially hazardous foods must be kept at 41°F or below, or 135°F or above. Hot holding foods, food held at 45°F and/or
leftovers must be discarded at the end of the day.
• A calibrated and accurate metal probe thermometer must be able to measure food temperatures and must be accurate to
+/-2° in the intended range of use.
Initials
07/2020
YSESB Health Permit Application Page 3 of 4
SNACK BAR OPERATOR
HANDWASHING FACILITIES
• Handwashing facilities must be located inside all food and beverage snack bars.
• If the event exceeds three consecutive days, a pressurized handwashing sink with hot and cold running water and a minimum of 5
gallon water supply is required.
• If the event is three days or less, a temporary handwashing set-up is allowed inside the snack bar. This set-up requires a minimum of
5 gallons of preheated water, a hands-free spigot that provides continuous flow of warm water, and a separate waste receptacle.
• All handwashing facilities will be supplied with a pump soap dispenser and single-use paper towels. Hand sanitizers do not replace
handwashing.
Initia
ls
SNACK BAR CLOSURE
• All handling and preparation of non-prepackaged food will be done within an approved enclosure or compartment. The ceiling, walls
and floors of the enclosure must be constructed of acceptable materials such as, but not limited to, the following:
− Ceiling constructed of canvas or tarps
− Walls constructed of canvas, tarps, plywood, fine-mesh window screening
− Floors constructed of tarps, plywood, concrete, asphalt. The floor must be smooth and cleanable
• Grass or dirt floors must be covered with appropriate smooth and cleanable materials.
•
The food service opening can be no larger than 13.5” or 16” with the ability of being closed.
Initials
EQUIPMENT AND UTENSILS
• All food-related and utensil-related equipment must be approved by EHS. All equipment will be installed, used and stored in such a
manner that prevents food contamination.
• Cold holding units include, but are not limited to: mechanical refrigeration, freezers or ice chests. Accurate thermometers are
required inside the units to monitor temperatures.
• Hot holding units include, but are not limited to: steam tables, crock-pots, chafing dishes or hot holding cabinets. All units must be
pre-heated prior to placing the food in the unit.
• All cooking equipment must remain inside the approved enclosure, unless specifically exempted by EHS.
• Open-air barbeques must be protected from dust and other contamination by way of an approved lid or overhead protection.
• Food preparation surfaces must be easily cleanable and made of approved materials.
• All condiments must be dispensed from a squeeze bottle, pump dispenser, or condiment containers with self-closing lids. Approved
individual packets will be handed out upon request.
Initials
WAREWASHING SINK AND WASTEWATER
• A 3-compartment warewashing sink with dual drainboards with overhead protection required for all food/beverage preparation
snack bars.
• All warewashing sinks will be supplied with a minimum of 25 gallons of pressurized warm water (minimum of 100°F), unless food
preparation is limited, then 15 gallons is required. Wastewater must be contained at all times.
• An approved sanitizer must be used at the event for sanitizing utensils and food-contact surfaces. Approved sanitizers include
chlorine (bleach), quaternary ammonia (Quat) or iodine. Sanitizer test strips must be available used to monitor sanitizer levels, and
correspond to the sanitizer in use at the event.
• All wastewater from warewashing sinks and handwashing facilities must be disposed of in an approved manner through a public
sewer system or other manner approved by EHS.
Initials
ELECTRICITY
•
Adequate electricity must be available for refrigeration units or other equipment.
• If the event extends into the evening hour or will last more than one day, ensure electricity will be available to power lights used to
illuminate food preparation area.
• Sources of electricity may include public utilities and/or generators.
Initials
07/2020
YSESB Health Permit Application Page 4 of 4
SNACK BAR OPERATOR
ADDITIONAL INFORMATION
• If food preparation is in a permitted facility, the permit must be provided.
• Snack bars must be supplied with potable (drinking) water for food preparation, handwashing, and warewashing.
• Garbage/trash must be frequently picked up and disposed of properly.
• Animals and smoking are prohibited within 20 feet of snack bars.
Initials
DECLARATION AND SIGNATURE
I declare under the penalty of law, that to the best of my knowledge and belief, the statements made herein are correct and true.
I have knowledge of, and commit to meet state law and relevant local regulations pertaining to the YSESB Health Permit. I acknowledge
the receipt of the Snack Bar Operator Checklist and the rules and regulations set forth by San Bernardino County.
As the Snack Bar Operator, I will ensure that my Snack Bar is in compliance with the Snack Bar operating requirements mentioned in
this application and set forth in the Snack Bar Operator Guidelines. I hereby consent to all necessary inspections related to the
issuance of a Health Permit and the operation of the business. Furthermore, I understand that failure to meet all requirements specific
to the Health Permit, supplemental attachments and those set forth by San Bernardino County may result in permit suspension and/or
closure of the Snack Bar.
Indemnification: The Contractor agrees to indemnify, defend (with counsel reasonably approved by County) and hold harmless the
County and its authorized officers, employees, agents and volunteers from any and all claims, actions, losses, damages, and/or liability
arising out of this contract from any cause whatsoever, including the acts, errors or omissions of any person and for any costs or
expenses incurred by the County on account of any claim except where such indemnification is prohibited by law. This indemnification
provision shall apply regardless of the existence or degree of fault of indemnities. The Contractor’s indemnification obligation applies to
the County’s “active” as well as “passive” negligence but does not apply to the County’s “sole negligence” or “willful misconduct” within
the meaning of Civil Code Section 2782.
☐ Electronic Signature Only By checking this box I confirm I am submitting this application
electronically and that the information on this form is true and correct. I also acknowledge
that I have read, understand and accept any terms and conditions of this form.
Date:
Signature of Snack Bar Operator:
Print Name:
Title:
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YOUTH SPORTING EVENT SNACK BAR HEALTH PERMIT APPLICATION (County of San Bernardino Information Services Dept.)

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Completed 5 May 2021

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