HomeMy WebLinkAboutplan-check-questionnaire-ada Ronald Browder
Director
ALAMEDA COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
PLAN REVIEW QUESTIONNAIRE FOR FOOD ESTABLISHMENTS
1.What type of food establishment will this be? _ _
2. Name of Business: _
________________________________________
_________________________________________________________________
3.Address of Business: ________________________________________________________________
4. Will there be a Cannabis Manufacturing facility? _______________________________________
5.Will there be a Hood System (additional fees required per system)? ______________________
a. How many Hood Systems (additional fees required per system)? __________________
6. Will there be any handling of unpackaged foods or drinks? ______________________________
a. Portioning, cutting, dispensing, etc.? ___________________________________________
b.Cooking? ____________________________________________________________________
c. Deep fat frying? ______________________________________________________________
d.Charbroiling or barbecue? _____________________________________________________
7. Will there be a Salad Bar or other self-service foods? ___________________________________
8. Will there be any Catering? __________________________________________________________
If yes, submit a Catering SOP
9. Does any of the food items prepared require a HACCP or ROP? __________________________
10. Will there be a Shellfish Tank (oysters, clams, etc.)? ____________________________________
11. Will there be a tank for Finfish or Crustaceans? ________________________________________
12. On-site eating or drinking? Exclusively Take-out? _______________________________________
13. Will multi-use eating & drinking utensils be used? ________ Single Service Utensils? _______
14. Will you have a Dishwashing Machine? ________________________________________________
a. If yes, will it be high temperature or chemical (low temperature)? ______________
15. Will sinks be used for washing produce, thawing of foods, or other food preparation? ______
16. Is there a Pick-up Area for third party delivery services or to go customers? _______________
17. Number of employees on site? _______________________________________________________
18.What is the total square footage of floor space? ________________________________________
19. What is the seating capacity? ________________________________________________________
20. Will alcoholic beverages be served on the premises? ___________________________________
21. Is the proposed location zoned for the proposed use? ___________________________________
22.Is the facility on a Septic System? ____________ Is the facility using Well Water? ___________
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23.Is this a new construction or a remodel? ______________________________________________
24. If a remodel:
a. Will this be a change in type of operation?
b. Name and type of previous business ________________________________________
c.What changes will be made? (size, equipment, facilities, etc.) _________________
25. If new construction:
a. New building? ____________________________________________________________
b. Name and type of business there now? _____________________________________
c. The building is how many stories high? ______________________________________
d. Is there a basement? ______________________________________________________
If yes, how will it be used? __________________________________________________
26.Is the building part of a shopping mall or center? _______________________________________
27. Are there any common or shared facilities? If so, specify (restrooms, storerooms, garbage
area, others) ________________________________________________________________________
28. Business owner’s name: _____________________________________________________________
Business owner’s phone number: __________________ email: ____________________________
Business owner’s address: ___________________________________________________________
29. Property owner’s name: _____________________________________________________________
Property owner’s phone number: __________________ email: ____________________________
Property owner’s address: ___________________________________________________________
30.Architect’s name: ___________________________________________________________________
Architect’s phone number: ________________________ email: ____________________________
31. Contractor’s name: _________________________________________________________________
Contractor’s phone number: ______________________ email:____________________________
32. Provide a copy of the proposed menu.
33. Provide a copy of menu of the existing food establishment.
1131 Harbor Bay Parkway, Alameda, CA 94502 Health.AlamedaCountyCA.gov/ACEHD 510) 567-6700