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, WILLIAMS STATE SERVICE CENTER 805 RIVER ROAD DOVER, DE 19901 (Hours: 8:00 AM to 4:30 PM, Monday - Friday. Telephone: 302-739-5305; Fax 302-739-7013) 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.) 2. Type of Food Operation (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.# 35-05-20/03/04/10 DELAWARE HEALTH \ AND SOCIAL SERVICES Division of Public Health HEALTH SYSTEMS PROTECTION SECTION Office of Food Protection 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 THIS PAGE IS A DATE: ____/____/_______ ESTABLISHMENT: SAMPLE ONLY SUBMITTED BY: ____________________________ ITEM ITEM DESCRIPTION MANUFACTURER MODEL NO. 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/ Eagle Metalmasters 414-18-3- 2 drainboards & grease trap 24 below 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 17 18 19 20 Note 1: Equipment numbers refer to corresponding location of Equipment on floor plan/layout drawings or diagrams. Note 2: Mention of trade names on this sample are used as Examples only and does not imply product endorsement. (PLEASE USE ADDITIONAL SHEETS, IF NECESSARY, TO CONTINUE EQUIPMENT SCHEDULE) DELAWARE HEALTH DIVISION OF PUBLIC HEALTH AND SOCIAL SERVICES HEALTH SYSTEMS PROTECTION OFFICE OF PLAN REVIEW AND PERMITTING 417 FEDERAL STREET, DOVER DE 19901 APPLICATION FOR PERMIT TO OPERATE A RETAIL 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) ESTAB. TEL. NO.: ______ - ______ - _______ FAX NO.: _______ - _______ - _______ 2. APPLIC. NAME AND PERM MAIL ADDRESS 3. SEAS/TEMP MAIL ADDRESS (IF APPLICABLE) TEL NO: ______ - ______ - ________ TEL NO: _______ - ______ - ________ _____________________________________________________________________________ 4. MAIL CORRESPONDENCE TO (CHECK ONE): ____ ADDRESS SHOWN IN LINE #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 BUS. ID: ____________ _____________________________________________________________________________ TYPE OF PERMIT REQUESTED (CHECK ALL THAT APPLY) 1. ___ FOOD SERV. (RESTAURANT) 2. ___ RETAIL FOOD STORE 3. ___ FOOD PROCESSOR 4. ___ VENDED FOOD 5. ___ ICE MANUFACTURING _____________________________________________________________________________ TYPE OF BUSINESS ENTITY 1. ___ INDIVIDUAL 2. ___ PARTNERSHIP (NAME: _______________________________) 3. ___ ASSOC. (NAME: _______________________________________________________) 4. ___ CORP. (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 INSPECTED AND APPROVED FOR OPERATION. UPON APPROVAL, 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 FOOD CODE” 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 DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health PLAN REVIEW AND APPROVAL FOR FOOD ESTABLISHMENTS 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 categories 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 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 DATE: ____/____/________ ESTABLISHMENT: ___________________________________________ SUBMITTED BY: ___________________________ ITEM ITEM DESCRIPTION MANUFACTURER MODEL NO. 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 (The sample diagram located here is not reproducible in text format. Please contact the Office of Plan Review, Permitting and Enforcement for a complete packet including the diagram.) (This space is occupied by a sample of graph paper in 1/4 –inch grid size and is not reproducible in text format. Please contact the Office of Plan Review, Permitting and Enforcement for a complete packet including the graph paper.) FOOD ESTABLISHMENT FLOOR PLAN & EQUIPMENT LAYOUT Scale ¼" = 1 foot (If other scale, specify: __________) NAME OF FOOD EST. ____________________________ Submitted by: __________________