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Home My WebLink Aboutsponsor-application-ada Ronald Browder Director Page 1 of 5 1131 Harbor Bay Parkway, Alameda, CA 94502 | Health.AlamedaCountyCA.gov/ACEHD | (510) 567-6700 Alameda County Environmental Health Department – Sponsor Application Health Permit Application for Sponsors of Food Facilities at Temporary Events in Alameda County Excludes Berkeley Office Use Only Date Rec’d ________ Rec’d By __________ Amt $ _______ EV# ____________ Approved By ________ Date _______ Name of Event ______________________________________________________________________________________ Location of Event & City ______________________________________________________________________________ Date(s) of the Event ______________________________________________ Time of Day ________________________ ☐ Indoor ☐ Outdoor ☐ Other Number of Mobile Food Trucks ___________ Number of Temporary Food Booths _________ Permit Fees 1-4 Contiguous Days (Same Event)Up to 12 Months Program Element 1911 1913 1914 1915 50+ Food Facilities *Fee with penalty $327 $523.50 $649.50 $612 +https://deh.acgov.org/operations-assets/docs/tff/Fee-Exemption-Requirements.pdf *Applications and payment received less than 5 working days prior to the event will be charged a 50% penalty. *All Fee Exempt permit applications received less than 5 days prior to an event are subject to a $54.00 penalty. FA# Person in Charge ____________________________________________ Title ___________________________________ _________________________________________________ Street # Street Name _________________________________________________ City State Zip Mailing Address __________________________________________________ Street # Street Name _________________________________________________ City State Zip Please complete all pages of the Application Page 2 of 5 Note: If an event is cancelled or an application is rejected, 50% of the application fee may be refundable. Email your application to dehtempevent@acgov.org or walk-in your application to 1131 Harbor Bay Pkwy Alameda CA 94502-6540. To pay by credit card: follow the instructions emailed to you from our Finance Department sent with your invoice. Call 510-567-6858 if you need online payment assistance. A 14 business day hold will occur before issuance of permit(s) if paying by check. Application completed by __________________________________________ Title ________________ Signature of Applicant _____________________________________________ Date ________________ Phone _____________________ Contact Phone # the day of the Event _________________________ Approvals Please obtain all required local city/country permits and approvals, e.g. Business License, Fire Department, Street Use and Insurance Carrier. California Health and Safety Code Section 114381.1 A Sponsor/Organizer Permit is required for each event. Permits must be obtained prior to the event. Permits must be posted at each Food Facility Booth. Submit a Site Plot Plan (Health and Safety Code section 114381.1) Submit two sets of plans, 10 working days prior to event date, indicating the proposed location of the following: 1. Location of each food facility including food booths. 2. Show location of Potable Water Supply and Waste Water disposal area. 3. Show location of toilet and handwashing facilities and note the quantity at each location. For every 15 food handlers (about 1 toilet per 4 booths). Provide additional toilets for the public. 4. Trash, Manure, and Grease disposal containers. 5. Common Food Storage Facilities (Dry of Refrigerated storage). 6. Write in the distances from food booths to all other facilities on plot plan. Please complete all pages of the Application Page 3 of 5 Water Supply Location of potable water ____________________________________________________________________________ Quantity of potable water (at least 20 gallons/booth per day) ____________________________________________ Maximum distance to a temporary food booth from the water supply _____________________________________ Liquid Waste Disposal Location of disposal _________________________________________________________________________________ Type of container or disposal method _________________________________________________________________ Capacity of container ________________________________________________________________________________ Trash, Grease and Manure Disposal Number of containers provided _________ How often are trash containers emptied? _____________________________________________________________ If animal manure is present, how often is it removed? __________________________________________________ Is there a central refuse collection site? (Indicate it on the plan.) Yes No Is there a secondary refuse collection site? (Indicate it on the plan.) Yes No Person(s) Responsible for trash/manure removal. Name _______________________________________ Address ______________________________________________ Toilet Facilities A minimum of one toilet for every 15 food handlers is required. Number of toilets: FIXED ________________ PORTABLE ________________ (with water, soap & towels inside) Location and distance from food facilities. Location ______________________ Maximum distance from food facilities ___________ feet (show on plan) Do the toilet facilities have Yes No Give details _________________________________________________________________________________________ Lighting and Electrical If it is a night event, will you have lighting? Yes No Give details _________________________________________________________________________________________ Is electrical service provided for mobile food facilities and/or equipment at food booths? Yes No One handwashing station per food booth is required and will be provided by: Event Sponsor OR Booth Operator What type of hand wash station will be provided? Minimum: (1) 5 gallons of warm water Permanent Plumbed facilities (2) Liquid soap and single use towel Temporary facilities (3) Wastewater container Other _______________________ Please complete all pages of the Application Page 4 of 5 Sponsor Contract Regulations for Sponsors of Food Facilities operating at Community Events 1. Submit a completed sponsor application form at least 10 working days prior to the planned event date. 2. Conﬁrm that every food vendor has a current health permit issued speciﬁcally for the event (original permits must be posted for public view at each facility/booth). 3. Provide solid and liquid waste receptacles, portable toilets (1 per 15 persons), and sufficient hand washing facilities furnished with liquid soap and disposable paper towels. 4. Provide site maps, detailing the locations of the food courts, toilets, hand washing facilities, solid and liquid waste disposal sites. 5. Protect the employees of the Alameda County Environmental Health Department from any abuse or harassments by individuals or representatives of other organizations, while the county employees are performing their assigned duties. 6. Pay for any or all unpermitted food facilities found operating at the event without prior authorization from the Alameda County Environmental Health Department. 7. I agree that failure to comply with any or all of the above stated regulations may be a sufficient reason to deny me the issuance of a sponsor health permit now and in the future. 8. I will renew my Sponsor Permit at least two weeks prior to the permit expiration date if the event occurs in the same location with the same schedule (weekly, bi-weekly, monthly, etc.). 9. Complete the Sponsor’s Food Vendor List on page 5 or submit your own. Permit Applications submitted without an attached Sponsor’s Food Vendor List will be rejected. Name of the Event: _________________________________________________________________ Location of the Event and City: ______________________________________________________ Date(s) of the Event: ________________________________________________________________ Sponsor’s Name: ___________________________________________________________________ Sponsor’s Signature: ___________________________________ Today’s Date: ______________ Permit Questions: Stephanie.Lee@acgov.org Unit Supervisor: Valerie.Strother@acgov.org Please complete all pages of the Application Page 5 of 5 SPONSOR’S FOOD VENDOR LIST EVENT NAME: ________________________ EVENT DATE(S): ___________ EVENT START TIME: ___________ NAME OF TEMPORARY FOOD BOOTH LIST ALL FOOD TRUCK, TRAILERS AND CARTS AND ATTACH A COPY OF THE CURRENT HEALTH PERMIT 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 12 12 13 13 14 14 15 15 16 16 17 17 18 18 19 19 20 20 21 21 22 22 23 23 24 24 25 25 26 26 Sponsor Name: __________________________ Phone: _______________________ Cell: ____________________