SAN DIEGO STATE UNIVERSITY
ENVIRONMENTAL HEALTH AND SAFETY DEPARTMENT
EVENT ORGANIZER PERMIT APPLICATION
This Organizer* Permit Application must be completed and submitted to Environmental Health and Safety Dept. at San Diego State University
(EHSfoodsafety@mail.sdsu.edu , Hardy Tower 58, FAX x42854 or MC 1243) including all required documents, at least two weeks prior to the event, unless
otherwise specified. Once approved, a temporary food facility permit will be issued. Changes cannot be made without EHS approval. For questions or
information, call (619) 594-2865.
*Note: An organizer is a person or organization responsible for the temporary food facility that is shared by two or more permitted temporary food facility
operators.
Department/Organization Name:
Event Organizer:
Event Name:
Event Description:
Event Type:
Dept Chair/Org Pres:
Email:
Phone #:
Fundraising Event
Other:
High School Conference
Event Approval System (EAS) #:
Aztec Nights
Green Fest
Greek Week
Farmer’s Market
Private i.e. Members only; by invitation only
Public i.e. Open to anyone on campus
Food and Beverages will be Served or Offered for Sale to:
Location:
Campanile Walkway
Courtyard
Other:
IVC Campus
Other:
Event Date(s):
Anyone
Members only
Invitation only
Centennial Walkway
Aztec Student Union [@
Montezuma Hall
]
President Black’s Quad
Scripps Cottage
Sports Field
Prep Time:
Service/Sale Time:
Organizers only
Theatre
End of Service/Sale Time:
Provide EHS with the following information with this application:
1. Food Vendor List – Name of Vendor; Person In Charge and Contact Information of Vendor;
2. Site Map including the location of:
 Each food/beverage vendor
 Potable water supply
 Handwashing facilities
 Warewashing sinks (3-compartment minimum within 100ft)
 Restrooms within 200 feet of food booths
 Waste water disposal
 Trash Dumpsters
Number of temporary food facility operators expected to participate:
Have all food vendors been advised of the EHS, SDSU requirements for participating at this event?
Will there be a Certified Producer or Processed Food Vendor participating at this event?
Will there be a planning meeting for food booth participants?
If yes, date, time and location:
Will electricity be provided for the food booths?
If yes, what is the source?
Public Utility
Generator(s)
Will equipment/utensil washing facilities be available?
If no, how will equipment/utensils be washed?
If yes, where will equipment/utensil washing facilities be located?
Are restroom facilities within 200 feet?
Water supply source:
Public Water Supply
How will waste water be disposed?
Public Sewer
Other:
Other:
Describe garbage/trash disposal:
Rev. 07/15
EHS, SDSU
SAN DIEGO STATE UNIVERSITY
ENVIRONMENTAL HEALTH AND SAFETY DEPARTMENT
EVENT ORGANIZER PERMIT APPLICATION
FOOD VENDOR LIST
Event Name:
Date(s) of Event:
Organizer:
NAME OF VENDOR
& TYPE OF FOOD
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Vendor Name:
___________________________
Check if applicable:
___Pre-Packaged Only
___Open Food
Rev. 07/15
Location:
Cell Phone:
PERSON-IN-CHARGE
MENU ITEMS
List Major Menu Items
BUSINESS TYPE
Name:
___________________________
Address:
___________________________
Check one:
___________________________
Permit #: ________________
Exp. Date:
___________________
Phone:
___________________________
Name:
___________________________
Address:
___________________________
___________________________
Phone:
___________________________
Name:
___________________________
Address:
___________________________
___________________________
Phone:
___________________________
Name:
___________________________
Address:
___________________________
___________________________
Phone:
___________________________
Name:
___________________________
Address:
___________________________
___________________________
Phone:
___________________________
Name:
___________________________
Address:
___________________________
___________________________
Phone:
___________________________
Name:
___________________________
Address:
___________________________
___________________________
Phone:
___________________________
___Nonprofit
___Licensed Business
Check one:
___Nonprofit
___Licensed Business
Permit #: ________________
Exp. Date:
___________________
Check one:
___Nonprofit
___Licensed Business
Permit #: ________________
Exp. Date:
___________________
Check one:
___Nonprofit
___Licensed Business
Permit #: ________________
Exp. Date:
___________________
Check one:
___Nonprofit
___Licensed Business
Permit #: ________________
Exp. Date:
___________________
Check one:
___Nonprofit
___Licensed Business
Permit #: ________________
Exp. Date:
___________________
Check one:
___Nonprofit
___Licensed Business
Permit #: ________________
Exp. Date:
___________________
EHS, SDSU
SAN DIEGO STATE UNIVERSITY
ENVIRONMENTAL HEALTH AND SAFETY DEPARTMENT
EVENT ORGANIZER PERMIT APPLICATION
Provide all food vendors with an Application for Temporary Food Facility Operator Permit or
Producer/Processor Permit and notify applicants that they must return applications to EHS no later than two
weeks prior to the event. Each vendor must apply and obtain a permit. The Event Organizer is responsible for
ensuring that all participating vendors are permitted.
This is to certify that the information provided is true and correct. I hereby consent to all necessary inspections made pursuant to
law and incidental to the issuance of this permit and the operation of this business. I understand that non-compliance with the
requirements can result in immediate closure, loss of future privileges and disciplinary action. The university is not responsible for
any outbreak of foodborne illness from special event food service, sale or promotion.
Event Coordinator:
Permit Issued:
EHS Signature:
Rev. 07/15
Date:
___Not Required
___Yes
Food/Bev Coord:
Date:
EHS USE ONLY
___Incomplete Submission
Date:
EHS, SDSU