Temporary Food Facility (TFF) Permit Application

Temporary Food Facility (TFF) Permit Application

A temporary food facility permit will be required for food given away or sold to the campus community and/or general public. Failure to adhere to Temporary Food Facilities guidelines or activities identified by an EH&S representative to not meet California Health & Safety Code, may be subject to immediate closure and destruction of adulterated foods. If your event is private and not open to the campus community and/or general public then a food permit is not necessary. Invited guests do not count as the campus community/general public.

Event Name*

Booth Location/Space*

25Live Reservation #

(Format ####-ABCDEF)

Event Start Date

(Format MM/DD/YYYY)

Event End Date

(Format MM/DD/YYYY)

What is the duration of the event?

Example: 1 hour; 4 hours; 8 hours

What time will the food booth begin setup?*

Select or enter value

What time will food services begin?*

Select or enter value

What time will food services end?*

Select or enter value

CPP Organization Name

Advisor's Name

Person-in-Charge (PIC) Information

Per CalCode, each food booth must have a PIC knowledgeable in food safety and monitor the food activity during the event.

Name (First and Last)

Email Address

Phone Number for Person-In-Charge of Booth

(Area code) xxx-xxxx

Name(s) of Designated Food Handlers

Anyone preparing or handling open food for this event must have a valid ANSI accredited Food Handler's Certification. ANSI accredited Certified Food Manager's Certificate is also acceptable.

Please list the food item(s) intending to be sold/given away.*

E.g., Potato Chips, Donuts, Cotton Candy, Boxed meals, and etc.

Where is the food/ingredients being purchased?

Please provide the business name and address.

Are all food items individually prepackaged?*

Select

List the food item(s) not individually prepackaged

Where will the food be prepared or cooked?

Select

What is the business name, address of the kitchen?

Food Preparation or Dispensing Procedure*

Please describe the method of preparation or dispensing the foods listed above in detail.

How will the food be kept cold or hot to avoid reaching Danger Zone temperatures?*

Danger Zone Temperature: 41F -135F degrees

Booth Type*

Select

Handwashing*

Select

Utensil Wash

Select

File Upload

Attachments needed:

• Food Handler Card(s)

Drag and drop files here or

Certification

By checking the boxes and entering my name below, I hereby declare and affirm that the facts stated in this application are true and correct to the best of my knowledge, information, and belief.

CPP Temporary Food Facility Guidelines

I hereby certify that my TFF workers and I have reviewed the campus Temporary Food Facility guidelines.*

I hereby agree not to store or prepare food for the event in any private residence.*

I understand I must have a valid Temporary Food Facility Permit readily available upon request at the event.*

Failure to adhere to campus Temporary Food Facilities Guidelines or activities identified by an EH&S representative not to meet California Health & Safety regulations may be subject to immediate closure and destruction of foods being offered or prepared. EH&S may seek further disciplinary action if patterns of unapproved activities persist.*

Signature-Name

Print Your Name to Certify the Above is True and Correct.

Send me a copy of my responses

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