DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health APPLICATION REQUIREMENTS TO OBTAIN AN OPERATING PERMIT UPON CHANGE OF OWNERSHIP OF A FOOD ESTABLISHMENT NEW OWNER OR OPERATOR: Use these forms only if there will be no change from the previously permitted operation in type of food establishment, type of food operation, occupancy type, structure, plumbing, equipment, or floor plan. If such changes are made or are planned, request information for Plan Review. The review and approval of plans and specifications are required before construction of a food establishment; conversion of an existing structure to a food establishment; remodeling of a food establishment; or when there is a change in type of food establishment or type of food operation. For food establishments in NEW CASTLE COUNTY, DELAWARE within ten (10) business days, mail or deliver the following completed documents to: ENVIRONMENTAL HEALTH FIELD SERVICES NEW CASTLE COUNTY HEALTH UNIT, LIMESTONE PROFESSIONAL BLDG 2055 LIMESTONE ROAD, SUITE 100 WILMINGTON, DE 19808 (Hours: 8:00 AM to 4:30 PM, Monday - Friday. Telephone: 302-995-8650; Fax 302-995-8323) For food establishments in KENT COUNTY, DELAWARE within ten (10) business days, mail or deliver the following completed documents to: ENVIRONMENTAL HEALTH FIELD SERVICES KENT COUNTY HEALTH UNIT, THOMAS COLLINS BUILDING 540 SOUTH DUPONT HIGHWAY, SUITE 5 DOVER, DE 19901 (Hours: 8:00 AM to 4:30 PM, Monday - Friday. Telephone: 302-744-1220; Fax 302-739-1957) For food establishments in SUSSEX COUNTY, DELAWARE within ten (10) business days, mail or deliver the following completed documents to: ENVIRONMENTAL HEALTH FIELD SERVICES SUSSEX COUNTY HEALTH UNIT, GEORGETOWN STATE SERVICE CENTER 544 SOUTH BEDFORD STREET GEORGETOWN, DE 19947 (Hours: 8:00 AM to 4:30 PM, Monday - Friday. Telephone: 302-856-5496; Fax 302-856-5065) PLEASE PROVIDE THE FOLLOWING COMPLETED DOCUMENTS: 1. Application for Permit to Operate a Food Establishment (Use blank form attached.) 2A. Type of Food Operation (Use blank form attached.) 2B. Food Preparation Review (Use blank form attached.) 3. Current or proposed menu (Include your own menu.) 4. Equipment schedule, indicating Item, Manufacturer, and Model Number of each major piece used for cooking purposes (ranges, grilles, woks, etc.); hot holding; cold holding, including refrigeration and freezer units; manual and mechanical warewashing equipment; and installed ventilation units. Correlate equipment listed to locations indicated on the floor plan. 5. Floor plan, scaled 1/4” = 1 foot, showing the entire facility, including food preparation areas, food and beverage dispensing areas, food and utensil storage areas, warewashing areas, utility areas, and all toilet facilities. Equipment locations shown on the floor plan shall correlate to items listed on the equipment schedule. Doc. No. 35-05-20/08/07/07 FOOD PROTECTION PROGRAM IMPORTANT NOTE Failure to provide the required documents within ten (10) business days may be construed to be operating a food establishment without a valid permit. The matter will be referred to the enforcement section and may result in administrative action to cease operations. SUMMARY OF REGULATIONS EXCERPTED FROM STATE OF DELAWARE FOOD CODE 8-301.11 Prerequisite for Operation. A person may not operate a food establishment without a valid permit issued by the Division of Public Health. 8-302.11 Submission 30 Calendar Days Before Proposed Opening. An applicant shall submit an application for a permit at least 30 calendar days before the date planned for opening a food establishment or the expiration date of the current permit for an existing facility. 8-303.20 Existing Establishments, Permit Renewal, and Change of Ownership. The Division of Public Health may renew a permit for an existing food establishment or may issue a permit to a new owner of an existing food establishment after a properly completed application is submitted, reviewed, and approved, the fees are paid, and an inspection shows that the establishment is in compliance with the Food Establishment Regulations. FOOD ESTABLISHMENT PERMIT FEE FEE IS DUE UPON RECEIPT OF INVOICE. NON-PROFIT ORGANIZATIONS ARE EXEMPT FROM FEES. Food establishments are charged the following annual, non-refundable fees, based on type of facility: 1. Public Eating Place $ 100.00 2. Retail Food Store $ 100.00 3. Ice Manufacturer $ 30.00 4. Commercial Food Processor $ 30.00 5. Vending Machine Location $ 30.00 Note: The permit fee is not due until the facility is approved for an operating permit. At that time, an invoice will be sent to the establishment owner or operator. PLEASE CONTACT THE ENVIRONMENTAL HEALTH FIELD SERVICES OFFICE LISTED ON PAGE 1 TO SCHEDULE THE REQUIRED PRE-OPERATIONAL INSPECTION. SATISFACTORY FACILITY COMPLIANCE IS REQUIRED PRIOR TO ISSUANCE OF THE PERMIT TO OPERATE A FOOD ESTABLISHMENT. SAMPLE MENU THIS PAGE IS A SAMPLE ONLY ****************************************************************************************************************************** YOUR FOOD ESTABLISHMENT SUBS SMALL LARGE Regular............................................................. $ 00.00 $ 00.00 Italian............................................................. 00.00 00.00 Ham................................................................. 00.00 00.00 Cheese.............................................................. 00.00 00.00 Turkey.............................................................. 00.00 00.00 Tuna................................................................ 00.00 00.00 Capicola............................................................ 00.00 00.00 Roast Beef.......................................................... 00.00 00.00 Extra Cheese........................................ 00.00 Sweet/hot peppers................................... 00.00 Additional extras no charge: Pickles, diced hot peppers All subs include: Lettuce, tomato, cheese, onion, and mayo or oil ***************************************************************** SANDWICHES (your choice of bread) Ham and cheese................... $ 00.00 Bologna.......................... 00.00 Turkey........................... 00.00 Roast beef....................... 00.00 Extras: Cheese, tomato, sweet peppers ***************************************************************** STEAKS Steaks (plain)................................................... $ 00.00 $ 00.00 Cheese Steak..................................................... 00.00 00.00 Mushroom Steak................................................... 00.00 00.00 Cheese & Mushroom................................................ 00.00 00.00 Extras on steaks: Tomatoes............................................. $ 00.00 00.00 Extra Cheese........................................ 00.00 00.00 Extra Steak.......................................... 00.00 00.00 Hamburger...................................................... $ 00.00 00.00 Cheeseburger.................................................. 00.00 00.00 Hot Dog......................................................... 00.00 00.00 French Fries.................................................... 00.00 00.00 SAMPLE CONSUMER ADVISORY DISCLOSURE: CERTAIN MENU ITEMS LISTED ABOVE, IF COOKED TO ORDER, MAY CONTAIN RAW OR UNDERCOOKED INGREDIENTS. REMINDER: CONSUMING RAW OR UNDERCOOKED FOODS OF ANIMAL ORIGIN, INCLUDING MEATS, POULTRY, SEAFOOD, SHELLFISH, AND EGGS, MAY INCREASE YOUR RISK OF FOODBORNE ILLNESS, ESPECIALLY IF YOU HAVE CERTAIN MEDICAL CONDITIONS. SAMPLE FOOD ESTABLISHMENT EQUIPMENT SCHEDULE NAME OF FOOD ESTABLISHMENT: THIS PAGE IS A SAMPLE ONLY SUBMITTED BY: DATE: ____ / ____ /____ ITEM NO. ITEM DESCRIPTION MANUFACTURER MODEL NO. 1 Exhaust hood Captive–Aire Systems Custom Fab 2 Range, 6 burner, gas Garland Ind H-286 3 Countertop griddle U.S. Range Inc TB-24GG 4 Deep fryer Frymaster MJ 45 E 5 Deep fryer Frymaster MJ 45 E 6 Refrigerator, reach-in True Mfg Co TSTL–49 7 Freezer, reach-in Victory HAF–2–PS 8 Prep table, stainless steel Falcon Fabricators 66-548 9 Prep table, laminated top King Concepts Custom Fab 10 Handwashing sink (3 each) Advance Tabco 7-PS-HC 11 Warewashing sink, 3-cmpt w/ 2 drainboards & grease trap below Eagle Metalmasters 414-18-3-24 12 Service sink, floor-mounted Eagle Metalmasters F1916 13 Ice maker, with storage bin Manitowac JR0405A W/C470 14 Wait station King Concepts Custom Fab 15 16 Note 1: Equipment numbers refer to corresponding location of equipment on floor plan/layout drawings or diagrams. 17 18 Note 2: Mention of trade names on this sample are used as examples only and does not imply product endorsement. 19 (PLEASE USE ADDITIONAL SHEETS, IF NECESSARY, TO CONTINUE EQUIPMENT SCHEDULE) APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT SECTION A: IDENTIFICATION – Please print legibly in all blocks below, except where signature is required. 1. NAME AND LOCATION OF FOOD ESTABLISHMENT (Enter Street Address. Do Not Use P.O. Box Numbers) E-MAIL ADDRESS: __________________________________ TEL NO. OF ESTABLISHMENT: _________ -- _________ -- _______________ FAX NO. _________ -- _________ -- _______________ 2. NAME AND PERMANENT MAILING ADDRESS OF APPLICANT 3. SEASONAL/TEMPORARY MAILING ADDRESS (IF APPLICABLE) TEL NO. _________ -- _________ -- _______________ TEL NO. _________ -- _________ -- _______________ 4. MAIL CORRESPONDENCE TO (CHECK ONE): _____ ADDRESS SHOWN IN BLOCK #A1 _____ ADDRESS SHOWN IN BLOCK #A2 SECTION B: CLASSIFICATION TYPE OF FOOD ESTABLISHMENT (CHECK ALL THAT APPLY) 1. _____ FIXED LOCATION 2. _____ MOBILE UNIT (SPECIFY FACILITY USED AS SERVICING AREA ___________________________________________) 3. _____ SEASONAL (SPECIFY DATES OF OPERATION _______________________________________________________) - IF THIS IS A CHANGE OF OWNERSHIP, INDICATE BELOW THE PREVIOUS FOOD ESTABLISHMENT NAME, IF KNOWN. PREVIOUS NAME: ______________________________________________ PREVIOUS BUSINESS ID: __________________ TYPE OF PERMIT REQUESTED (CHECK ALL THAT APPLY) 1. _____ FOOD SERVICE (RESTAURANT) 2. _____ RETAIL FOOD STORE 3. _____ FOOD PROCESSOR 4. _____ VENDED FOOD 5. _____ ICE MANUFACTURING TYPE OF BUSINESS ENTITY 1. _____ INDIVIDUAL 2. _____ PARTNERSHIP (NAME: ______________________________) 3. _____ ASSOCIATION (NAME: ______________________) 4. _____ CORPORATION (NAME: ______________________________) 5. ? OTHER ENTITY (SPECIFY TYPE: _________________________________________________________________________) 6. INTERNAL REVENUE SERVICE STATUS (CHECK ONE) _____ FOR PROFIT _____ NON – PROFIT NOTE: NON-PROFIT ORGANIZATIONS ARE EXEMPT FROM FEES. IF CLAIMING EXEMPTION FROM FEES, ATTACH A COPY OF INTERNAL REVENUE SERVICE (IRS) 501[C][3] LETTER. FEES: PLAN REVIEW IS REQUIRED FOR NEW CONSTRUCTION, STRUCTURE CONVERSION TO FOOD ESTABLISHMENT, REMODELING, OR CHANGES IN ESTABLISHMENT TYPE OR FOOD OPERATION TYPE. PLEASE INCLUDE THE REQUIRED NON-REFUNDABLE FEE WITH THIS APPLICATION. MAKE CHECK PAYABLE TO “STATE OF DELAWARE.” THE ESTABLISHMENT PERMIT FEE IS NOT DUE UNTIL THE FACILITY IS APPROVED FOR OPERATION. AT THAT TIME, AN INVOICE WILL BE SENT TO THE ESTABLISHMENT APPLICANT. SECTION C: CERTIFICATION STATEMENT (APPLICANT SIGNATURE IS REQUIRED BELOW. DO NOT PRINT) I, THE UNDERSIGNED, IN APPLYING FOR A FOOD ESTABLISHMENT PERMIT, ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED IN THIS APPLICATION. I AFFIRM THAT THE ESTABLISHMENT WILL BE OPERATED IN COMPLIANCE WITH APPLICABLE “STATE OF DELAWARE REGULATIONS GOVERNING FOOD ESTABLISHMENTS” AND WILL ALLOW AUTHORIZED REPRESENTATIVES OF THE DIVISION OF PUBLIC HEALTH ACCESS TO THE ESTABLISHMENT AND ITS RECORDS, AS MAY BE REQUIRED BY APPLICABLE REGULATIONS. APPLICANT SIGNATURE X_______________________________________________________ DATE _______ / _______ / ________ FOR OFFICIAL USE ONLY BELOW THIS LINE APPLICATION REVIEWED: APPROVED_____ DISAPPROVED_____ BY_________________________ DATE _____________ Doc.# 35-05-02/99/09/19 PERMBILL BUSINESS ID (PERMIT) NO:______________________________________ TYPE OF FOOD OPERATION APPLICANT: (PRINT) __________________________________________________ DATE: ____/____/____ FOOD ESTABLISHMENT NAME: ____________________________________________________________ Changes in the type of food operation may require review and approval of plans and specifications by the Division of Public Health to ensure compliance with current Food Establishment regulations. Check one or more items below to indicate type of food operation(s) ___ PREPARATION AND SALE OF NON-POTENTIALLY HAZARDOUS FOOD.* ___ PREPARATION, SALE AND SERVICE OF POTENTIALLY HAZARDOUS FOOD;* Only to order upon a consumer’s request. ___ PREPARATION, SALE AND SERVICE OF POTENTIALLY HAZARDOUS FOOD;* In advance, in quantities based on projected consumer demand, and discards food that is not sold or served, at an approved frequency. ___ PREPARATION, SALE AND SERVICE OF POTENTIALLY HAZARDOUS FOOD;* In advance, in quantities based on projected consumer demand, and discards food using time as the public health control. ___ PREPARATION, SALE AND SERVICE OF POTENTIALLY HAZARDOUS FOOD;* In advance, where preparation involves two or more of the following steps: combining potentially hazardous ingredients; thawing; cooking; cooling; reheating; hot holding, cold holding; or freezing. ___ PREPARATION, SALE AND SERVICE OF POTENTIALLY HAZARDOUS FOOD;* In advance, where preparation involves two or more of the following steps: combining potentially hazardous ingredients; thawing; cooking; cooling; reheating; hot holding; cold holding; or freezing. For delivery to and consumption at a location off the premises of the food establishment where it is prepared. ___ PREPARATION, SALE AND SERVICE OF POTENTIALLY HAZARDOUS FOOD;* In advance, where preparation involves two or more of the following steps: combining potentially hazardous ingredients; thawing; cooking; cooling; reheating; hot holding; cold holding; or freezing. For service to a highly susceptible population.** DEFINITION OF TERMS * Potentially Hazardous Food : food that is natural or synthetic and that requires temperature control because it is in a form capable of supporting the rapid and progressive growth of infectious or toxigenic organisms. ** Highly Susceptible Population : a group of persons who are more likely than other populations to experience foodborne disease because they are immunocompromised, or older adults and in a facility such as a hospital or nursing home, or preschool age children in a facility such as a day care center. FOOD ESTABLISHMENT EQUIPMENT SCHEDULE NAME OF FOOD ESTABLISHMENT: SUBMITTED BY: DATE: ____ / ____ /____ ITEM NO. ITEM DESCRIPTION MANUFACTURER MODEL NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 (PLEASE USE ADDITIONAL SHEETS, IF NECESSARY, TO CONTINUE EQUIPMENT SCHEDULE) SAMPLE FOOD ESTABLISHMENT FLOOR PLAN A copy of the Sample Food Establishment Floor Plan is available from the Office of Food Protection. FOOD ESTABLISHMENT FLOOR PLAN & EQUIPMENT LAYOUT Scale ¼” = 1 foot (If other scale, specify: _______________ ) THIS PAGE IS A SAMPLE ONLY NAME OF FOOD EST. _______________________________________________ Submitted by: _____________________________ A copy of the Sample Food Establishment Floor Plan is available from the Office of Food Protection. FOOD ESTABLISHMENT FLOOR PLAN & EQUIPMENT LAYOUT Scale ¼" = 1 foot (If other scale, notify:_____________) NAME OF FOOD EST._____________________________________Submitted by:______________________________ FOOD PREPARATION REVIEW 1. IDENTITY OF FOOD PREPARATION REVIEW Name of Food Establishment ______________________________________________________________________ Applicant ______________________________________________________________________________________ Address of Food Est. _____________________________________________________________________________ ______________________________________________ Phone:_______________________ 2. FOOD ESTABLISHMENT OPERATING CHARACTERISTICS A. Total square footage of food establishment premises: ______________SQ FT B. Number of floors on which food operations are conducted: ___________FLOOR(S) C. Type of meal service to be provided: (Check all that apply) _____ Take Out Food _____ Seated Dining _____ Mobile Food Unit _____ Delivery of Prepared Food _____ Catering on premises _____ Catering off premises _____ Highly Susceptible Population* (see definition below) * Highly Susceptible Population: a group of persons who are more likely than other populations to experience foodborne disease because they are immunocompromised, or older adults and in a facility such as a hospital or nursing home, or preschool age children in a facility such as a day care center. D. Number of seats for dining: Interior ______________ Exterior __________________ E. Hours of operation: Sun __________ Mon_________ Tue _________ Wed _________ Thu _________ Fri _________ Sat_________ If seasonal, specify approximate dates of operation: From _______________________ To _____________________ F. Approximate daily maximum number of meals to be served: Breakfast: ____________ Lunch: ____________ Dinner: ____________ 3. FOOD HANDLING PROCEDURES In each of the following sections, please provide a brief description of your standard procedures to ensure that food is safe, unadulterated, and honestly presented when offered to the consumer. Please use additional sheets, if necessary. A. Receiving Approved Source How will you ensure that all foods are purchased from inspected and approved sources, such as retail store, purveyor, commercial processor, etc.? _______________________________________________________________________________________________ _______________________________________________________________________________________________ B. Storage Protection from Contamination, Refrigerated and Frozen How will you ensure that foods are maintained at 41?F or below, or frozen food maintained frozen? _______________________________________________________________________________________________ _______________________________________________________________________________________________ FOOD PREPARATION REVIEW How will you prevent cross-contamination between raw foods (meats, poultry, seafood) and cooked ready-to-eat foods? _______________________________________________________________________________________________ _______________________________________________________________________________________________ C. Preparation Protection from Contamination How will frozen foods be thawed before cooking? _______________________________________________________________________________________________ _______________________________________________________________________________________________ How and where will foods (meat, poultry, seafood, produce) be washed and rinsed on-premises? _______________________________________________________________________________________________ _______________________________________________________________________________________________ How will you minimize the time foods are in the Danger Zone (41?F - 140?F) during preparation? _______________________________________________________________________________________________ _______________________________________________________________________________________________ How will ready-to-eat foods made by combining ingredients, such as tuna or chicken salad, be chilled after preparation? _______________________________________________________________________________________________ _______________________________________________________________________________________________ D. Cooking Destruction of Organisms How will you measure the required final cooking temperatures of potentially hazardous foods (thermometers, etc)? _______________________________________________________________________________________________ _______________________________________________________________________________________________ E. Service Limiting Growth of Organisms How will hot foods be maintained at 140?F or above during hot holding for service (steam tables, warmers)? _______________________________________________________________________________________________ _______________________________________________________________________________________________ How will cold foods be maintained at 41?F or below during cold holding for service (cold pan units, buffet tables, etc)? _______________________________________________________________________________________________ _______________________________________________________________________________________________ D. Cooling Limiting Growth of Organisms How will foods be cooled from 140?F to 70?F within 2 hours and from 70?F to 41?F within 4 hours (ice bath, etc.)? _______________________________________________________________________________________________ _______________________________________________________________________________________________ E. Reheating Limiting Growth of Organisms Describe how foods for hot holding will be rapidly reheated to 165?F for 15 seconds within 2 hours (range, microwave). _______________________________________________________________________________________________ _______________________________________________________________________________________________ F. Disposal Segregation and Disposition of Distressed or Contaminated Food Describe the location for separation of contaminated/distressed foods. Describe your procedures to discard foods from unapproved sources, adulterated foods, and foods contaminated by employees or consumers. _______________________________________________________________________________________________ _______________________________________________________________________________________________ Thank you for completing this Food Preparation Review. For information concerning the food safety principles involved in these procedures, consult the State of Delaware Food Code, or contact the Office of Food Protection.