Mobile Retail Plan Review Packet
All items, listed below, must be submitted before a license can be issued.
❑Completed Plan Review Packet
❑
Proposed Menu
❑
Certified Food Protection Manager Certification
❑
Layout of Mobile Unit (photos or drawing). If photos are provided, ensure that photos are taken
inside and outside the mobile unit and include pictures of water tanks, water inlets/outlets, water
heaters, hand sinks, refrigerators, and any equipment used to prepare food.
❑
Plan Review Application Fee ($100.00 is due at time of submission)
❑License Application (including state sales tax number)
❑
Fire Department Approval Form (if applicable)
❑
Sales Tax License (obtained from Colorado Department of Revenue*)
❑Commissary Agreement
❑
Affidavit-Restrictions on Public Benefits (if applicable)
❑Written Operational Plan (self-contained units only)
❑
Pre-opening/Final Inspection (once all other items checked off) will be conducted at commissary.
OTHER INFORMATION:
• Fees for license, and inspection and review time will be collected at final inspection.
• Inspection and review time is billed at $80.00 per hour.
•
Colorado Department of Revenue: 303-238-7378 (Denver)
970-494-9805 (Fort Collins)
https://www.colorado.gov/pacific/tax/how-apply-colorado-sales-tax-license
All fees must be paid before
license will be issued.
MOBILE UNIT PLAN REVIEW FORM
ESTABLISHMENT INFORMATION
Name of Mobile Unit: Phone:
Type of Unit:
□
Mobile (Trailer/Food Catering Truck)□
Push Cart□
Self-Contained Unit1Street Address: Cell:
City: Fax:
State/Zip: Email:
County: Website:
OWNERSHIP INFORMATION (proprietary rights per C.R.S. 25-1605)
Individual(s) or Corporate Name: Phone:
Mailing Address: Cell:
City: Fax:
State/Zip: Email:
CONTACT INFORMATION (
□
CHECK IF SAME AS ABOVE )Name of Primary Contact: Phone:
Street Address: Cell:
City: Fax:
State/Zip: Email:
LICENSING INFORMATION
Has your mobile unit been previously licensed in Weld? YES / NO
If YES, provide the following information Previous Name:
State & County where licensed: If NO, is the construction of the mobile unit complete?
Days and Hours of Operation
Insert hours in the following format: 8am to 8pm
Days: Hours:
Seasonal: Yes ☐ No ☐ List months of operations:
Projected maximum number of meals to be served.
Number of meals per week:
1- Self-Contained Mobile Unit: See definition and additional requirements. Annex Page 11
Provide information on how people can find your mobile unit.
3
MENU AND FOOD HANDLING PROCEDURES
A. Check all the food handling procedures that apply and indicate the location where they will take place in Table 1 below.
FOOD HANDLING PROCEDURES
Procedure Y N
If yes, indicate where procedure will take place
Commissary Mobile
Will food be held cold? Will food be held hot?
Will produce need to be washed? Will food be cooled after cooking? Will food be reheated after cooling?
Will food that is frozen need to be thawed? Will food be cooked? (example: raw meat) Will facility serve raw, undercooked, or cooked to order eggs, meat, poultry, or fish? Will foods be prepared that will be sold to other establishments?
Will catering be conducted?
** Food shall be obtained from approved sources that comply with the applicable laws relating to food and food labeling** **Preparation of food or storage of any items related to the operation is prohibited in a personal home.**
Food Handling Procedure Descriptions
Complete Applicable Sections
A. List the foods that will require rapid cooling (examples: salsa, beans, rice, green chili, soup, etc.):
In addition, describe what methods will be used in your facility to rapidly cool cooked food. Check only those that apply in your establishment.
☐Under refrigeration ☐Ice water bath ☐Adding ice as an ingredient
B. Describe what methods will be used in your facility to rapidly reheat cooled foods/leftovers.
List the equipment that will be used for reheating:
☐ Stove ☐ Microwave ☐ Other: ________________________________________ C. Describe how frozen foods will be thawed.
☐ Under refrigeration ☐ Under running water ☐ In a microwave
☐ As part of cooking process ☐ Other: ________________________________
D. Describe where personal items will be stored.
E. Describe where chemicals used for operation will be stored.
F. How will bare hand contact with ready-to-eat foods be prevented during preparation? Check all that apply.
☐ Gloves ☐ Utensils ☐ Deli Tissue ☐ Other:_____________________
5
Example
PHYSICAL FACILITIES
FINISH SCHEDULE
INSTRUCTIONS: Indicate which materials (quarry tile, diamond plate, linoleum, stainless steel, certamic tile, fiberglass reinforced panels (RFP), 4” rubber coved molding, etc.). Indicate Not Applicable (NA) as appropriate.
Floors Walls Ceiling Material Finish Type of
Base Material Finish Material Finish
Diamond Plate Smooth Rubber Cove FRP Smooth FRP Smooth
Windows and Doors: To prevent the entry of pests, outer openings must be protected.
Are windows and doors screened? YES NO N/A, unit is a push cart
If no, please describe how the unit will be protected from pest entry:
___________________________________________________________________________ Are service windows self-closing? YES NO N/A, unit is a push cart
If no, please describe how the unit will be protected from pest entry:
________________________________________________________________________________________________________
Ventilation:
If the mobile unit is enclosed and grease-cooking is conducted, such as cooking meats on a stove top or deep frying, a Type 1 hood is required.
If applicable, provide specification sheets for the exhaust hood and fan, and provide the hood information in Table 3 below. Provide the size in feet (length x width) of hood. Include manufacturer’s recommended exhaust listings in cubic feet per minute (CFM)s.
I plan to cook meats or other grease producing foods inside the unit. I understand a type 1 hood with fire suppression is required.
I plan to cook meats or other grease producing foods on one external piece of equipment (such as grill or smoker).
I understand that a deep fryer is not approved to be located outside the mobile unit.
grill or smoker). I understand that a deep fryer is not approved to be located outside the mobile
unit. VENTILATION
Hood Type (Type 1 or Type 2)
Dimensions (feet) of Hood (length x width)
REFRIGERATION / FREEZER CAPACITY
TYPE OF UNIT # OF UNITS PROVIDED Make & Model Number
Reach-in Cooler (under counter) Reach-in Cooler (stand up) Open Top Sandwich Cooler Reach-in Freezer (under counter) Reach-in Freezer (stand up) Other cold holding storage:
HOT HOLDING UNITS
TYPE OF UNIT # OF UNITS PROVIDED Make & Model Number
Steam Tables Hot Box
Cook & Hold Units
Other hot holding storage:
UTENSILS AND WAREWASHING
A. Where will utensil washing take place? (Check all that apply) Commissary
Mobile Unit
B. If utensil/equipment washing will take place on the mobile unit, provide specifications for the 3-compartment sink in Table 6 below.
MANUAL WAREWASHING LENGTH (inches) OF SOILED
DRAINBOARD
DIMENSIONS OF (inches)
SINK COMPARTMENTS LENGTH (inches) OF CLEAN DRAINBOARD
LENGTH WIDTH DEPTH
7
WATER SYSTEMS:
A. Provide plumbing diagrams or schematics showing location of water heater, plumbing fixtures, water supply and wastewater tanks, drain lines and water inlets/outlets on the floor plan. Materials used in the construction of a mobile water tank and accessories shall be safe, durable,
corrosion resistant, and finished to have a smooth easily cleanable surface. A water tank, pump,
and hoses shall be flushed and sanitized before being placed in service after construction, repair, modification, and periods of non-use. 5-304.11
B. Hot Water
1. How will hot water be provided to plumbing fixtures on the unit? (Check all that apply) Water Heater
Instantaneous water heater
Other (such as passive system):___________________________________________________ 2. If a water heater is installed, complete the table below:
WATER HEATER- Standard Tank
Make Model # KW/BTU Rating Tank Capacity WATER HEATER- instantaneous
Make Model # GPM @ 80°F Rise
C. Water Tank Sizes
a. Provide total capacity of potable water tanks (in gallons): _________ b. Provide wastewater tank capacity (in gallons): ________
NOTE: The wastewater tank must be at least 15% larger than water supply tank.
D. Water Supply Information and Disposal Information Provide location where water will be obtained below.
_____________________ __________________________ _________________ _____________
Business Name Street Address City State/Zip
Provide location where wastewater will be disposed of below.*
_____________________ __________________________ _________________ _____________
Business Name Street Address City State/Zip
E. What plumbing fixtures will be present on the mobile unit? (Check all that apply) 3-compartment sink
Hand sink (Indicate number of sinks): __________ Food preparation sink
Pre-rinse sprayer Mop sink
Toilet
Other (specify): ______________________________________________________________
F. Please describe how clean water tank will be filled:
______________________________________________________________________________________ ______________________________________________________________________________________ G. Please describe how waste water tank will be emptied:
______________________________________________________________________________________ ______________________________________________________________________________________
Note: Hoses used to fill clean water tank shall be food grade.
H. Prevention of Cross-Contamination to Water Supply: How will you ensure there is no cross-contamination between the drinking water and waste water tanks and hoses? (Check all that apply)
Drinking water inlet above waste outlet Different colored or sized hoses
Different colored or sized removable tanks Different threads on inlet and outlet
Other (specify):_______________________________________________________________ Be Advised: Take necessary steps to winterize the mobile unit by insulating pipes (chemical additives are
not allowed). Temperatures in Colorado frequently drop below 32°F and may cause water tanks and hoses to
freeze resulting in damage to the system. Ensure pipes, water heater, and storage tanks in your unit are completely drained during cold weather months. Without water you cannot operate your mobile unit.
I, _____________________________________ of ____________________________________
(Commissary Owner/Operator)
(Commissary Name)
located at _____________________________________________________________________
(Address of Commissary, City, Zip)
give permission to ______________________________ of _____________________________
(Mobile unit owner name)
(Mobile Unit Name)
to use my kitchen facilities to perform tasks related to their mobile unit operation such as food
storage, cleaning of equipment, filling water tanks, dumping water waste, and food preparation
activities.
The mobile unit will have access to my facilities at the following times and days:
Days mobile has access to the commissary: Mon Tue Wed Thur Fri Sat Sun
Hours mobile has access to the commissary: ____ am/pm to _____ am/pm
Requirements of the mobile unit retail food establishment:
The mobile unit is required to return to the commissary daily for servicing on operating days.
The mobile unit is required to maintain a commissary log indicating the dates and times that they
used the commissary at the commissary facility.
Requirements of the commissary:
Once the mobile food facility has been approved for licensing, you agree to notify the Weld
County Department of Public Health and Environment if the above-mentioned mobile unit has
not utilized your facility as required. You also certify under penalty of perjury that you are the
legal owner and/or operator of this food facility and will abide by the contents of this agreement.
By signing this you acknowledge that misuse of the commissary by a mobile unit could
potentially affect your retail food license. Contact us immediately if you believe the mobile unit
is operating out of the scope of this agreement.
_____________________________________
___________
Signature of commissary owner
Date
_____________________________________
Print Name
Self-Contained Mobile Units
I would like to register as a self-contained unit.
In addition to completing this plan review packet a written operational plan must be
submitted (separate document).
By registering as a self-contained mobile unit, I understand that the following is generally
required to be installed in order to be considered self-contained (note: requirements may
vary based on menu and operations- this is intended to be a guide):
1) At least one hand sink.
2) A 3 compartment sink large enough to fit equipment that needs to be washed.
3) A mop sink.
4) Adequate size and type of refrigeration for my menu and processes.
5) Adequate water and waste water (tank size can vary but are usually larger than 50
gallons in size with waste tank being 15% larger).
6) Adequate hot water. Water heater generally will be 10-20 gallons in size (for standard
tanks) and instantaneous units should provide 2.5-3 gpm at an 80 degree rise.
7) A food preparation sink may be required.
11
Annex: Mobile Unit General Requirements
NOTE: The following list of requirements has been provided to assist with frequently asked
questions specific to mobile unit plan reviews. The list does not represent the entirety of the requirements.
I. HANDWASHING SINKS
A. Handwashing sinks must be capable of providing a hands-free, continuous flow of 100°F water delivered under pressure.
B. Handwashing sinks must be easily accessible at all times and used for no other purpose.
II. VENTILATION
A. If the mobile unit is enclosed (floors, hard sided walls, ceiling) and grease-cooking is conducted (i.e. cooking meats on a stove top or deep frying), then a Type 1 hood is required.
B. A single smoker, grill, or oven may be used outside the unit, provided that all foods are prepared, assembled, and served from within the mobile unit and not from the external piece of cooking equipment.
III. WATER SUPPLY
A. Water must be obtained from an approved source.
B. For pushcarts, the water supply tank must have a minimum capacity of at least five gallons. C. For mobile units equipped with a three-compartment warewashing sink, the water supply
must be sized to adequately fill warewashing sinks at least every four hours of operation. D. The mobile unit must supply three gallons of water to each handwashing sink for each hour
of operation. For example, a mobile unit operating for six hours must have a minimum of 18 gallons of drinking water available just for the hand sink. Water can be provided through additional food grade containers if approved by the Department.
E. Adequate water pressure must be provided to all fixtures at all times.
F. Only food-grade hoses can be used to fill or transfer drinking water to or within a mobile unit.
IV. WASTEWATER
A. All wastewater (except water from clean ice) must be contained in a permanently installed holding tank that is at least 15% larger than the water supply tank.
B. Wastewater from the holding tank must be disposed in an approved sanitary sewer system (e.g. toilet or plumbed drain) daily. The wastewater holding tank must never be emptied onto the ground or in the storm drainage system.
C. When using wastewater containers that are not attached to the unit (pushcarts), they must be clearly marked and used for no other purpose.
between drinking water and wastewater.
E. The connections that release or catch wastewater must be located below the connections on the water supply tank in order to prevent contamination of the supply tank.
Additional Requirements for Self-Contained Mobile Retail Food Establishments NOTE: Mobile retail food establishments must use a commissary unless:
A. A pre-approved facility is provided and used to supply drinking water to the unit and for the disposal of wastewater generated by the unit.
B. The mobile unit’s drinking water system and waste retention system is sufficiently sized, operated properly to serve the needs of the unit, and liquid waste is emptied only at service locations that have been approved by the Department.
C. Adequate storage areas are provided within the mobile unit for all food, dry goods, single-service articles, and cleaning supplies.
D. Adequate facilities are provided for food preparation; cleaning and sanitizing of equipment and utensils; storage of additional food, equipment, utensils, and other supplies; and other servicing operations.
E. Adequate facilities, as required by the menu, are provided, including hand sink, food preparation sink, ware-washing facilities, mop sink, mechanical refrigeration, and any other necessary
equipment.
F. A written operational plan is submitted for the mobile unit demonstrating that its operation as a self-contained unit can be accomplished in compliance with the Colorado Retail Food
Establishment Rules and Regulations. Review and approval of the operational plan must include the menu and standard operating procedures for the unit. After an operational plan is approved, any additions or changes to the plan must be approved by the Department prior to
Subject: Implementation of C.R.S., 24-76.5-101, et. seq., “Restrictions on Public Benefits” (HB 1023) To Whom It May Concern:
You will find an affidavit included with your renewal registration/application. All licenses, certifications, and registrations issued to individual owners or sole proprietors by the Colorado Department of Public Health and Environment must be accompanied by verification of citizenship.
This requirement does not apply to you if you are not an individual owner or sole proprietor. Verification includes completing the affidavit and providing a notarized copy of an approved identification. Approved identification includes:
•
A valid Colorado driver’s license or a Colorado identification card;•
A United States military card or a military dependent’s identification card;•
A United States Coast Guard Merchant Mariner card;•
A Native American Tribal Document,In addition to the above listed forms of identification, the following will be allowed until March 1, 2007.
•
A certificate verifying naturalized status issued by an authorized agency of the United States bearingapplicant’s intact photograph impressed with the raised embossed seal of the issuing agency;
•
A certificate verifying United States citizenship issued by an authorized agency of the United Statesbearing applicant’s intact photograph impressed with the raised embossed seal of the issuing agency, or;
•
Other approved State’s driver’s license or identification card. Not all states verify lawful presence prior toissuing license. Therefore, only those States listed below are deemed acceptable.1
You may access a notary in your area by conducting a search through directory assistance for “public notaries.” C.R.S., 24-76.5-101, “Restrictions on Public Benefits” became effective August 1, 2006, and requires “each agency or political subdivision of the state” to verify the lawful presence in the United States of every applicant for public benefits. The law requires the verification of citizenship in order for persons eighteen years of age or older to receive certain benefits or obtain a license or certification from the department. If the recipient of the benefit is under eighteen years of age, the law does not apply.
If you need assistance in complying with this law or if there is additional information you feel we need to be aware of, please do not hesitate to contact me at (970) 304-6415.
Sincerely,
Gabrielle Vergara
Environmental Health Manager Environmental Health Services
1 Alabama, Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada,
AFFIDAVIT - RESTRICTIONS ON PUBLIC BENEFITS
I, , swear or affirm under penalty of perjury under the laws of the State of Colorado that (check one):
I am a United States citizen, or
I am a Permanent Resident of the United States, or
I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for a public benefit. I
understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
Doing Business As: Address:
Street Unit City Zip
Signature Date
As a Notary Public in and for the state of , I do certify that I carefully compared the copy of identification or other proof of citizenship with the original and that it is a complete, full, true, and exact copy of the document they have purported to reproduce.
Subscribed and sworn to before me this day of , 20
By .
Witness my hand and official seal. My commission expires:
Retail Food Establishment License Application
(as of September 1, 2018)
For Agency Use Only
Incomplete applications, or applications without payment (if required), will not be processed.
Ownership type:
Full legal name of owner, corporation, or non-profit:
Trade name (DBA): Contact name (on site): Email: CO Sales Tax Acct. No.
Physical address of business: City: State: Zip: County where business is located: Phone number: Other contact number (mobile, fax, etc.): Mailing address (if different from above): City: State: Zip: Date you started the business:
In consideration thereof, I do hereby certify that I have complied with all items of sanitation as listed in the Colorado Retail Food Establishment Rules and Regulations (6 CCR 1010-2), and that I have complied with all orders given me by authorized inspectors of the Colorado Department of Public Health & Environment, or local board of health. I also agree that in the event sanitation items are not complied with, I will discontinue serving food until such time as requirements are met.
Signature: Title: Date: Calendar Year: Individual (must complete affidavit of residency) Corporation (LLC, LLP, S-Corp, etc.) Non-profit (includes government) Other
Seasonal? Mark each month you operate: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Code Fee License Type
No fee license (K-12 schools, non-profits) 1000 $0.00 Limited food service (convenience, other) 2000 $270.00 Restaurant (0—100 seats) 3000 $385.00 Restaurant (101—200 seats) 3100 $430.00 Restaurant (> 200 seats) 3200 $465.00 Grocery store (0—15,000 sq.ft.) 4000 $195.00 Grocery store (> 15,000 sq.ft.) 4150 $353.00 Grocery store w/ deli (0—15,000 sq.ft.) 5000 $375.00 Grocery store w/ deli (> 15,000 sq.ft.) 5150 $715.00 Mobile unit (prepackaged) 6200 $270.00 Mobile unit (full food service) 6300 $385.00 Oil & Gas Temporary 7000 $855.00 Special Events 8000 Set locally
Total Due: $
Check the appropriate license type from the list below. This is your license fee.
Please remit payment to:
Weld County Department of Public Health & Environment 1555 North 17th Avenue Greeley, CO 80631
To pay with a credit card, please call: 970-304-6415
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
