Will the facility be Seasonal: operate six or fewer months a year? yes no Equipment washing method - check all that apply: Three Compartment Sink with drainboards High Temperature Dish Machine (sanitizes with water temperature of 180F or above) Low Temperature Dish Machine (chemical sanitizer) - Indicate method that will be used to monitor dispensing of sanitizer: visual audible alarm visual alarm YES NO Processes which may require submission of additional plans or records Will the facility have a soft serve ice cream / frozen yogurt machine? Will it be a heat treatment dispensing freezer? yes no Will the facility offer for sale in a ready-to-eat form: raw or undercooked meats, dairy, eggs (i.e. eggs cooked to order), fish (as in Sushi), poultry or shellfish (oysters)? Will the facility freeze fish to destroy parasites? Will the facility cook, cool, and reheat bulk quantities of food more than once per week? Will the facility use Time as a public health control for temperature controlled foods? Will the facility offer Off-site catering? Will the facility prepare food for resale at another location? Will the facility display for consumer self-service, unpackaged ready-to-eat foods? Will the facility repack bulk quantities of food for retail or wholesale? Will the facility have a bulk water dispenser or manufacture packaged ice? Will the facility only sell prepackaged foods from an approved source? YES NO Processes which may require a variance under 3717-1- 03.4 (J). Will the facility use smoke or curing agents (i.e. nitrates) to preserve foods? Will the facility use additives for food preservation or to render foods Non-potentially hazardous (i.e. acidified rice)? Will the facility process foods using Reduced Oxygen Packaging (i.e. Cryovac)? Will the facility operate a molluscan shellfish life-support system tank to store and display shellfish (i.e. oysters) that are offered for human consumption? Will the facility custom process animals that are for personal use as food and not for sale or service in a food service operation or retail food establishment? Will the facility produce canned or bottled food or drinks Will the facility press or bottle fruit or vegetable juices? Will the facility engage in any other process that requires a variance? 2014-03
Will the facility be Seasonal: operate six or fewer months a year? yes no Equipment washing method - check all that apply: Three Compartment Sink with drainboards High Temperature Dish Machine (sanitizes with water temperature of 180F or above) Low Temperature Dish Machine (chemical sanitizer) - Indicate method that will be used to monitor dispensing of sanitizer: visual audible alarm visual alarm YES NO Processes which may require submission of additional plans or records Will the facility have a soft serve ice cream / frozen yogurt machine? Will it be a heat treatment dispensing freezer? yes no Will the facility offer for sale in a ready-to-eat form: raw or undercooked meats, dairy, eggs (i.e. eggs cooked to order), fish (as in Sushi), poultry or shellfish (oysters)? Will the facility freeze fish to destroy parasites? Will the facility cook, cool, and reheat bulk quantities of food more than once per week? Will the facility use Time as a public health control for temperature controlled foods? Will the facility offer Off-site catering? Will the facility prepare food for resale at another location? Will the facility display for consumer self-service, unpackaged ready-to-eat foods? Will the facility repack bulk quantities of food for retail or wholesale? Will the facility have a bulk water dispenser or manufacture packaged ice? Will the facility only sell prepackaged foods from an approved source? YES NO Processes which may require a variance under 3717-1- 03.4 (J). Will the facility use smoke or curing agents (i.e. nitrates) to preserve foods? Will the facility use additives for food preservation or to render foods Non-potentially hazardous (i.e. acidified rice)? Will the facility process foods using Reduced Oxygen Packaging (i.e. Cryovac)? Will the facility operate a molluscan shellfish life-support system tank to store and display shellfish (i.e. oysters) that are offered for human consumption? Will the facility custom process animals that are for personal use as food and not for sale or service in a food service operation or retail food establishment? Will the facility produce canned or bottled food or drinks Will the facility press or bottle fruit or vegetable juices? Will the facility engage in any other process that requires a variance? 2014-03