1112 Joshua Ave., Parker AZ 85344
928-669-1100 Fax 928-669-6703
_______________________________
for Mobile Food Trucks, Mobile Food Units,
Food Boats, and Food Carts
La Paz County, Arizona
A copy of the Arizona Food Code is available online at: http://www.lpchd.com/uploads/1/1/6/4/11641401/fc2000.pdf www.lpchd.com
7/2014 Mobile Food Page 1

Application Process Notice
Licensing Time Frames
Definition of a Mobile Food Unit (MFU)
Health Department Office Hours
Types of Permits/Permit Fees
General Operating Requirements
Set-up of Unit
Signage and Operating Permits
Food Handlers Card Requirement/Food Safety Knowledge
Person In Charge
Commissary Requirement
Plan and Operating Information
Plan Requirements
Construction
Water/Wastewater Tanks
Exhaust Hood
Plumbing Specifications
Lighting Specifications
Food Boat
Food Cart
Enforcement
Variances
Application (Detach and Return)
A copy of the Arizona Food Code is available online at: http://www.lpchd.com/uploads/1/1/6/4/11641401/fc2000.pdf
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La Paz County Health Department/ Environmental Health
1112 Joshua Ave., Parker AZ 85344
928-669-1100 Fax 928-669-6703
Permits do not transfer to new owners
Under ARS §11-1606, La Paz County is required to give you the following information regarding the steps to obtaining a mobile food permit:
1.
Obtain a copy of the “Mobile Food Unit Guide” and read thoroughly. If you have questions, contact the Health Department at 928-669-1100 and ask to speak to a Health Inspector.
2.
Fill out application “Mobile Food Unit Application for an Annual Operating Permit” completely. Incomplete applications will delay permit approval or be denied.
3.
Application must be submitted at least 30 days prior to opening with the correct fee. Review/permit fees are nonrefundable.
4.
The Health Department will review and contact you via some type of written correspondence, either email or by letter with written approval OR a written list of deficiencies which must be addressed before approval can be issued.
5.
If deficiencies are listed, provide required information and resubmit.
6.
If approval is given, contact the office for a pre-opening inspection before opening.
7.
If approved to operate, approval will be given at pre-opening inspection and a permit to operate will be mailed to you. Permit must be posted in mobile food unit in view of customers and inspectors.
8.
Food handler cards are required. A copy of a food handler card from another jurisdiction may be submitted with appropriate fee ($15.00) and a La Paz County
Food Handler card will be issued. Otherwise, all food handlers must come to
Health Department for class and take the test.
Proof of Licensing Eligibility is required per AZ ARS 41-1080.
If a re-inspection is required during any part of the permitting or inspecting process, a re-inspection fee of $100.00 will be assessed.
If denied during any part of the permitting process, an appeal of the decision can be requested by written request to: Director of Environmental Health Division, 1112 Joshua
Ave., 206, Parker AZ 85344.
If application is not received at least 30 days before opening, a $50 late fee will be assessed and must be paid before permit is issued. www.lpchd.com
7/2014 Mobile Food Page 3

Time frames can be found in the Arizona Administrative Code, R9-8-104
Type of Approval Statutory
Authority
Overall Timeframe
Administrative
Completeness
Review
Substantive
Review
Food Establishment
License
Approval of Plans and Specifications under AZ Food Code
§8-201.11
Approval of HACCP
PLAN under AZ
Food Code §8-
201.13
Approval of Quality
Assurance Program
A.R.S. §36-
136(H)(4)
A.R.S. §36-
136(H)(4)
A.R.S. §36-
136(H)(4)
A.R.S. §36-
136(H)(4)
60
90
90
90
30
30
30
30
30
60
60
60
Questions? Call 928-669-1100 and ask for Health Inspector to answer questions. If you are unable to receive assistance from the inspector, you may contact the Environmental Health Director at 928-669-1100.
Under ARS §11-1609, you may request that the County clarify its interpretation of a statute, ordinance, regulation, delegation agreement, or authorized substantive policy statement that affects the issuance of your food establishment permit by providing the County with a written request that states:
1.
Your name and address;
2.
The statute, ordinance, regulation, delegation agreement, or authorized substantive policy statement that requires clarification;
3.
Any facts relevant to the requested ruling;
4.
Your proposed interpretation or part of the applicable statute, ordinance, regulation, delegation agreement, or authorized substantive policy statement that requires clarification;
5.
Whether, to the best of your knowledge, the issues or related issues are being considered by the County in connection with an existing license or license application. www.lpchd.com
7/2014 Mobile Food Page 4

A Mobile Food Unit (MFU) refers to an enclosed vehicle-mounted, boat-mounted, or trailer-mounted food establishment designated to be readily movable from which food is composed, compounded, processed or prepared and from which food is vended, sold, or given away as determined by the La Paz County Health Department. A Mobile Food
Unit will receive an annual permit to be renewed yearly on January 1. A Mobile Food
Unit can either be a “full-mobile” with attached water and wastewater tanks and able to travel county-wide or a “restricted” mobile, restricted to one location which has approved sewer connections and approved water connections at that space.
EXAMPLE OF A MOBILE FOOD UNIT
This is a fully enclosed, vehicle-mounted Mobile Food Unit
Each unit must be operated in full compliance with the La Paz County Regulations (including
Health Department and Zoning) and the Arizona Food Code (available online at http://co.lapaz.az.us/ ) and Town zoning and business regulations (contact Towns of Quartzsite and Parker).
Separate food permits will be required when operating on the Colorado River Indian Reservation
(CRIT) – please contact CRIT Health Department for more information.
Office Hours
Location: 1112 Joshua Ave., #206, Parker AZ 85344
Office Hours: Monday – Thursday, 7:00 am – 6:00 pm (Closed holidays)
Inspection Hours: BY APPOINTMENT ONLY in Parker Office
Call 928-669-1100 to schedule an appointment
Mobile Units must be brought to the Health Department main office for a pre-opening inspection and subsequent permit renewal inspections unless previous arrangements have been made.
All Mobile Food Units must be in full compliance before any permit will be issued including fully operational equipment and hot water to all sinks. Operating Permit must be posted inside of unit.
The following information is required to obtain a permit:
1.
Properly completed application with all supporting documentation including a drawing,
2.
Vending Route if applicable,
3.
Signed Commissary Agreement,
4.
Toilet Use Agreement (if applicable), and
5.
Permit Fee www.lpchd.com
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Type
Type 1
Limited
Mobile
Food Carts
(See specific requirements for Food
Carts)
Type 2
Moderate
Mobile
Type 3
Complex
Mobile
Types of Annual Permits/Fee Schedule for Mobile Food Units
Fee
$175.00
$150.00
$250.00
$350.00
Operation Requirements
Limited Preparation:
● Only pre-packaged potentially hazardous foods are available or sold; and/or
● The potentially hazardous foods served or sold are commercially pre-packaged in an approved food processing facility offsite; and/or
● The facility only has limited preparation of potentially hazardous foods and beverages; and/or
● The facility provides sampling of pre-packaged products or sampling of fruit/vegetables; and/or
● The facility only serves beverages.
(Commissary may be required).
Moderate Preparation:
● The food prepared in the facility is from raw ingredients and requires minimal assembly; and/or
● Hot or cold food prep in the facility is restricted to same day service; and/or
● Foods requiring preparation in the facility are from approved offsite processing facilities.
(Commissary may be required).
Complex Preparation:
● The facility prepares and holds hot or cold food for more than 12 hours before serving; and/or
● The facility cooks and cools three or more foods during the food handling process; and/or
● The facility prepares food for off-site service; and/or
● The facility vacuum packs food; and/or
● The facility serves a highly susceptible population.
(Commissary is required). www.lpchd.com
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General Operating Requirements for all Mobile Food Unit Permits
Food Products
1.
All food and beverages must be from an approved source
(USDA/FDA/State/County approved processing facility) and must be safe, unadulterated, and honestly presented. Homemade food products are prohibited including condiments.
2.
All packaged foods shall be labeled in English in accordance with FDA guidelines (product name, processor name, address/phone of processor, weight and ingredients list). Records of food purchases, invoices, and receipts must be kept with the operation and be available for review during routine inspections for at least 90 days following the date of purchase.
3.
All condiments must be dispensed from squeeze bottles, pump dispensers, individual packets, or condiment containers with self-closing lids.
4.
All potentially hazardous foods prepared in the mobile food unit must be prepared on the same day of sale or service. Hold over of potentially hazardous food from a previous day’s operation is prohibited.
Set-up of Unit
1.
All mobile food units must be maintained readily movable at all times.
2.
Temporary electrical connection may be used for units operating at a set location; however, the mobile food unit must have an alternate power source as a back up or the unit must close if power is interrupted.
3.
All food service and preparation must occur from within the mobile food unit or approved commissary. A variance for an outside bbq grill for meat can be allowed under certain conditions with variance application and variance fee ($75.00) submittal and approval from the Health
Department IF there is adequate cooking equipment inside the unit for cooking meat if required. Applicant must be able to show that food safety will not be compromised by cooking meat outside, showing proper food handling and food safety methods. www.lpchd.com
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Signage/Operating Permit
1.
Operating permits must be clearly visible from the serving window of the unit or driver’s side window. Photocopies are not allowed.
2.
Name of Business (name used on permit) must be clearly visible on outside of Mobile Food Unit.
Food Safety Knowledge
1.
Food service workers are required to obtain Food Handler cards. Please call 928-669-1100 for information on testing and locations.
2.
A Person In Charge is required to be on site during all times of operation. This is a person who oversees all aspects of food service and safety on the Mobile Food Unit and must be knowledgeable in food safety and have authority to make decisions about processes and food handling.
3.
Current La Paz County food handler cards must be posted inside of unit.
Failure to have cards posted is a critical violation and subject to enforcement action and $100 re-inspection fee.
4.
Proof of Licensing Eligibility is required per AZ ARS 41-1080.
The commissary is a base of operations for mobile food units selling potentially hazardous foods. Mobile food units are required to operate from an approved commissary unless the operator can show that all operations can take place within the unit.
The commissary is used to store food and food equipment, conduct food preparation such as cutting raw beef and preparing food, disposing of wastewater into a sanitary sewer, cleaning, and servicing unit.
Food for a Mobile Food Unit must be stored in the commissary if there is not room in the Mobile Food Unit for the storage. Mobile Food Units can not use tents or outside storage areas for storage of food and/or equipment. Food can not be stored in a private residence.
A commissary is a food establishment which is in compliance and is permitted/licensed by the La Paz County Health Department or other regulatory agency.
www.lpchd.com
7/2014 Mobile Food Page 8

Plans are a drawing or “bird’s eye view” of the mobile unit. Plans drawn to scale are required by the Arizona Food Code.
Plans can be submitted as part of the application or a separate set of plans can be submitted.
Generally, the plan review process takes at least 10 business days to complete so please plan accordingly. It is recommended that all information on the mobile food establishment be submitted at least
30 days prior to proposed opening date.
After the information has been reviewed, a Notification of Review letter will be mailed giving approval or explaining deficiencies with the plan and operating information. If approved, you may proceed with construction, remodeling, or conversion of the unit. If the reviewer lists changes to be made per The Arizona Food Code, you must make those changes on the plans/application/operating information and resubmit before approval will be given and a permit to operate will be issued.
When construction is complete, make an appointment for a pre-
must be clean and ready to operate and brought to the Health
Department main office unless other arrangements have been made with Health Inspector. www.lpchd.com
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The plans and specifications for all Mobile Food Units shall include the following information, all labeled clearly:
1.
Proposed layout, mechanical schematics, construction materials, and finish schedules.
2.
The plans should be submitted to scale (if possible) and must include the following: a.
Provide details in the plans such as the capacities, positioning, and placement of the potable water tank, wastewater tank, and hot water heater. In addition, the placement of the water inlets and outlets for the potable and wastewater tanks must be shown. b.
Show number, types, and location of all sinks and drain boards as well as dimensions for all sink compartments and drain boards. c.
Show all refrigeration and cold holding equipment and label. d.
Show food preparation and service areas. Provide the dimensions of the service windows. e.
Show the dry goods storage areas and food storage areas. f.
Show the location of vents for the water tanks, and the backflow prevention and overflow devices in the plumbing system. g.
Provide a finish schedule (i.e. stainless steel, FRP, etc.) for the floor, wall, and ceiling surfaces. h.
Show the design, positioning, and placement of the hood/ventilation system.
Example of Plans for a Food Truck:
www.lpchd.com
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The following list is meant to help outline certain requirements of the Arizona
Food Code. It is not all inclusive and other requirements may be applied depending on the menu and special needs of the unit.
General Specifications:
1.
Equipment must be constructed of approved material, be adequate in size, easily cleanable, and in good repair. Equipment design, construction, and installation must be certified by an ANSI (American National
Standards Institute) accredited certification program such as NSF, UL, or equivalent. The use of household refrigerators, stoves, sinks, vent hoods, and other equipment is NOT permitted.
2.
Food contact surfaces in the food preparation and utensil washing areas shall be free of breaks, open seams, cracks, chips, inclusions, pits, sharp internal angles, corners, and crevices.
3.
Wall surfaces may be FRP, stainless steel, or aluminum.
4.
Floor surfaces used may be aluminum diamond plate, stainless steel, or commercial grade vinyl composition tile or sheets.
5.
Ceiling surfaces can be stainless steel, plastic laminate, plastic coated fiberboard metal clad Fiberboard or FRP.
6.
Exterior surfaces must be weather resistant.
7.
Outer openings must be protected, there should be no gaps or holes at floors, walls, and ceilings.
Service Opening Specifications:
1.
The service windows must be protected against entrance of pests with approved, self-closing screen, windows, or mechanical air curtains over the windows, OR if screens are not available – the unit must close operation during times of dust/flies/birds/insects.
Sink Specifications:
1.
A permanently installed commercial grade hand wash sink must be provided in the food preparation area.
2.
A NSF approved (or equivalent) stainless steel three-compartment sink with two integral drain boards must be installed. Each compartment must be large enough to submerge the largest item to be washed.
3.
Sink faucets shall be mixing or combination type, shall provide at least 1 gallon per minute flow rate and shall reach all compartments in multi-compartment sink, with hot water available to all sinks www.lpchd.com
7/2014 Mobile Food Page 11

Water and Wastewater Tank Specifications:
1.
Provide a permanently mounted potable water tank that can hold a minimum capacity of
30 gallons. The potable water system must be directly and fully recharged when filled from a water inlet. The water heater capacity should be included in the potable water system capacity if the water from the water heater’s tank can be fully discharged when the potable water tank is empty.
2.
Provide a permanently installed wastewater storage tank that is 15% greater than the combined capacity of all tanks that can hold potable water. This would mean all potable water tanks plus the water heater tanks capacity.
3.
The water heater shall be of adequate capacity and recovery rate to furnish a continuous supply of hot water whenever the vehicle is in operation. Minimum capacity is 5 gallons.
4.
The water and wastewater tank requirement can be waived if the unit is set up in a location with approved sewer connections and potable water hookups. The mobile unit will be restricted to that location for the duration of the permit unless approval is received from the Health Department for a new location. The sewer and water hookups must be at the mobile food unit’s space and not adjacent or in another location.
This is a Mobile Food Unit.
Exhaust Hood Specifications:
1.
All hoods must comply with the latest Uniform Mechanical Code.
2.
Commercial cooking or display equipment which produces smoke, steam, grease, mists, particulate matter, condensation, vapors, fumes odors, or creates sanitation or indoor air quality problems will require a hood.
3.
Hoods shall be designed and installed to prevent grease and condensation from collecting on walls, ceilings, and from dripping into food or food contact surfaces.
4.
Canopy hoods must have a least a 6 inch overlap, over all cooking surfaces, on all open sides. All hoods shall be flashed solid to the ceiling or adjacent walls.
5.
Exhaust fans, makeup air fans, and inside fan motors on units supplying make-up air shall be interlocked so they operate simultaneously and shall be operated by a single switch.
6.
Hoods should be constructed to be NSF approved or equivalent in design, and meet local Fire Code. www.lpchd.com
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Plumbing Specifications:
1.
All materials used in the construction of the plumbing system must be drinking water approved, including water holding tanks, pipes, pumps, hoses, connections, etc.
2.
A food grade water hose must be provided and designated for drinking water use only. This hose is to be used only to fill the fresh water tank.
Store the hose on the vehicle with ends fastened together.
3.
All connections on the vehicle for waste disposal shall be of different size or type than those used for supplying potable water to these vehicles. The waste connection shall be located lower than the water inlet connection to preclude contamination of the potable water system.
In addition, wastewater outlets shall be greater than 1” unless otherwise approved by the Department.
4.
All water tanks, pumps, and hoses shall be flushed and sanitized before being placed in service after construction, repair, modification, and periods of non-use longer than 7 days. Potable water tanks shall be flushed and sanitized monthly.
Lighting Specifications:
1.
Minimum lighting requirements are 50 foot candles where a food employee is working with food.
2.
All bulbs must be shatterproof or shielded.
www.lpchd.com
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A Boat Mounted Mobile Food Unit
1.
All of the Guidelines for Mobile Food Units apply to boat-mounted mobile foot units.
2.
The watercraft’s kitchen and preparation area must be enclosed with outer openings screened, and must meet all requirements of the
Guidelines for Mobile Food Units as well as AAC, Title 9, Chapter 8,
Article 1 Food and Drink of the Arizona Food Code.
3.
All Equipment must be NSF approved, commercial grade equipment.
4.
Appropriate sinks must be available (handsinks and three bay sinks and prep sinks, if applicable) with hot water available to the sinks.
5.
A Toilet Use Agreement may be required if a restroom is not available on the boat.
6.
All boats must operate out of an approved commissary. A commissary agreement must be submitted with the application for permit. A new commissary letter must be filled out and signed each time the permit is renewed.
 There must be a water tank and wastewater tank sized to fit requirements of the Arizona Food Code.
 A complete application including drawing must be included.
 Grease must be disposed of properly in a greasetrap at commissary.
EXAMPLE OF FOOD BOAT Kitchen and prep area must be fully enclosed www.lpchd.com
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The Food Cart is a commercially manufactured food unit but is not fully enclosed. A variance is built into this permit. The Food Cart is restricted to non-potentially hazardous and must have a limited menu which is approved by the Health Department before operation.
1.
All food carts must be commercially designed and manufactured per NSF requirements or other accrediting agency.
2.
All equipment must be NSF commercial grade equipment, meeting all temperature requirements including cooling and cooking. No ice chests allowed.
3.
Handsink with hot water available must be built into unit.
4.
Food carts must be non-potentially hazardous food (popcorn, coffee, drinks). Exceptions allowed are coffee drinks with milk and hot dogs only. No chili or cheese or other potentially hazardous food can be served with hot dogs.
5.
The unit must have a commissary nearby or food preparation and storage of food or purchase food daily. Receipts for food must be kept on file at unit for 90 day minimum.
6.
A Toilet Use Agreement may be required.
7.
The Person In Charge must be onsite at all times.
8.
Cart can not operate during windy weather, when flies/birds/insects are present, or if other conditions exist which necessitate closure.
9.
Grease must be disposed of properly in a grease trap at commissary.
This is an Example of a Food Cart
An annual permit is allowed with a permitted commissary on file and a restricted menu.
Example of a Plan for a Food Cart www.lpchd.com
7/2014 Mobile Food Page 15

Detailed Plans must be submitted for Food Carts
1.
If a Mobile Food Unit or Food Cart is found operating out of compliance with state or local codes, and having a critical violation, it will be necessary for the food unit to close immediately if correction can not be made, and request an inspection for re-opening when in compliance with
Arizona Food Code ($100 re-inspection fee).
2.
FYI – Common violations include
-Not having food handler cards for all people working in the unit,
-No Person In Charge available in the unit,
-Food and supplies stored in tents or outside of unit,
-No screening available when flies are present.
1.
A variance is a written document issued by the Health Department that authorizes a modification or waiver of one or more requirements of the
Arizona Food Code if, in the opinion of the Health Department, a health hazard or nuisance will not result from the modification or waiver and IF it allowed by the Arizona Food Code.
2.
A Variance Request (Form F or Form E) must be filled out explaining what regulation (cite number and location) or section of the Arizona Food
Code is to be waived and what steps will be taken to insure that a food safety hazard or nuisance will not occur as a result of the variance.
3.
A Variance Request fee of $75.00 is assessed for each variance requested. A separate Form E (outside cooking) or Form F is required for each variance request.
4.
Variance Request Fee is not refunded in the event of a variance request denial.
5.
Variance forms are available from the Health Department website at www.lpchd.com
. www.lpchd.com
7/2014 Mobile Food Page 16

MOBILE FOOD UNIT (MFU)
Application for an Annual Operating Permit in La Paz County AZ
► Please submit at least 30 days in advance of anticipated operation
1. These Items MUST be included with the application ~
◊ Application and Fee(s) ◊ Complete Menu,
◊ Plan of Mobile Food Unit ◊ Variance Requst Form (Appendix E/F) & $75 Fee
◊ Licensing Eligibility information & Copy of ID ◊ Toilet Use Agreement if applicable (Appendix H)
◊ Photographs of the food unit, inside and out ◊ Vending Route if applicable (Appendix G)
◊ Nonprofit Status if applicable (Appendix B) ◊ Commissary Agreement (Appendix D)
2.Business Name
Name on side of unit
Owner/Operator Name
Home/Business Phone
Cell Phone Number
Email address
Mailing Address
3. Anticipated Opening Date:
Location:
Months of Operation:
Time(s) of Operation:
4.Will your operation be county-wide?
(Must have attached wastewater and water tank)
Attach a Vending Route or Calendar if known
If no tanks on unit, Location will be restricted.
5.Type of Food Service preparation
□
Vehicular Mounted
□
Trailer Mounted
□
Boat Mobile
□
Food Cart
□
County-wide mobile
□
One Location (Restricted Location)
□
Type 1 Mobile $175 OR
□
Type 1 Food Cart $150 ~ A commissary may be required.
● Only pre-packaged potentially hazardous foods are available or sold; and/or
● The potentially hazardous foods served or sold are commercially pre-packaged in an approved food processing facility offsite; and/or
● The facility only has limited preparation of potentially hazardous foods and beverages; and/or
● The facility provides sampling of pre-packaged products or sampling of fruit/vegetables; and/or
● The facility only serves beverages.
□
Type 2 Mobile $250 ~ A commissary may be required.
● The food prepared in the facility is from new ingredients and requires minimal assembly; and/or
● Hot or cold food prep in the facility is restricted to same day service; and/or
● Foods requiring preparation in the facility are from approved offsite processing facilities.
□
Type 3 Mobile $350.00 ~ Commissary required.
● The facility prepares and holds hot or cold food for more than 12 hours before serving; and/or
● The facility cooks and cools three or more foods during the food handling process; and/or
● The facility prepares food for off-site service; and/or
● The facility vacuum packs food; and/or
● The facility serves a highly susceptible population.
Miscellaneous Fees www.lpchd.com
7/2014 Mobile Food Page 17

Expedited Review Fee $ 50.00 Annual Food Handler Card $ 15.00
Variance Request Fee $ 75.00 Re-inspection Fee $100.00
________________________________________________________________________
6. Toilet Facilities may be required for employees if at a site longer than one hour. See requirements on Appendix H. Will you be at any one location longer than one hour and if so, are toilet facilities available?
Complete and submit Appendix H Toilet Use Agreement if using private toilet facilities, obtaining owner’s signature to allow usage of toilet facilities.
7. Where will food be purchased? Name of Store Town
Travel time from store to mobile food unit or commissary: _______________ minutes
How will food be kept cold or hot during travel time?
8. How will leftovers be handled at the end of the day?
9. Will you cook and then cool down food? Yes No
If yes, please describe your process for insuring the rapid cooling of cooked food:
Will all food be stored and prepared inside booth/mobile unit? Yes or No
Will you be using :
____ An offsite commissary (complete Appendix C Commissary Agreement Form)
Name of Commissary __________________
____An onsite commissary (separate application must be submitted )
____ Food will be purchased, prepared, and stored DAILY – all prep and storage inside of unit
10. Is food pre-cooked (in cans or frozen) and then reheated?
Or is food raw and then cooked to temperature?
If so, please describe cooking process (may use a separate page if necessary):
11. How will hot water be made available for handwashing and dishwashing?
13. Name of Public water system or name of hauled water company:
Size of potable water tank:
__________________gallons
12. Name(s) of Person(s) In Charge (a Person In
Charge must be present during all hours of operation):
Note: People working in food unit must have La Paz County
Food Handler Cards prior to working in the unit.
14.
Size of wastewater/graywater tank:
___________________ gallons
OR Name of sewer system:
What will you do with used grease? www.lpchd.com
7/2014 Mobile Food Page 18

15. How will electricity be provided to your unit?
16. Cooking Equipment. Please explain your method of cooking food – give types and number of units, manufacturer name, model, etc. - commercial grade equipment required for mobile food units.
NOTE: All equipment must have ANSI (NSF) certification.
17. List a full menu of items to be prepared and served.
18. Describe the utensil wash station and the procedure to wash, rinse, sanitize, and air dry utensils and equipment:
Number of sanitizer buckets for wiping clothes in MFU _____
Type of sanitizer:
Note: Sanitizer test strips must be available for use in unit.
19. Are you requesting a Variance/Waiver for the following (check as applicable)? Note: There is a $75.00 fee for each variance request.
□
Outdoor Cooking Variance (must have complete cooking equipment inside and meet variance requirements for outside cooking- see Appendix E BBQ Variance)
□
Other Variance – please explain on Appendix F General Variance www.lpchd.com
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20. Plan Drawing of Mobile Food Establishment
(Please draw to scale if possible -can be submitted on another page if necessary)
These items must be clearly shown on the plan: a.
All areas of food receiving, storage, preparation, cooking, cooling, service b.
Location of entrance and exits c.
Food service window d.
Equipment, all sinks, floor sinks, plumbing, lighting, water tank, wastewater tank
21. Material Schedule (Type of Construction Materials)
Please give construction materials for the following (example – wood, canvas, metal, tile, FRP)
Walls –
Ceiling –
Floor –
Doors/Entries –
Lighting -
Are shields available for all lighting?
NOTE: Service Counter (service counter must be manned AT ALL TIMES if unscreened. Screening must be available for windows and openings OR the unit must be closed during dust storms, weather events, or when insects/vermin/birds are www.lpchd.com
7/2014 Mobile Food Page 20

present)
22. Owner agreement and signature
◊
I have read the La Paz County AZ Mobile Food Establishment packet and understand that I must follow all of the requirements stated in the Packet as well as pertinent requirements of the Arizona Food Code.
◊
I understand that I must only prepare and serve food that was stated on my menu and approved by the
Health Department and that all food is to be prepared and served from the food unit unless a variance has been obtained from the Health Department.
◊
I understand that the Health Department can close my food establishment for critical violations. I understand that reinspections because of a critical violation including lack of current food handler cards will incur a $100 reinspection fee due at reinspection.
◊
I understand that all workers in the booth even if they do not cook the food must obtain a La Paz County food handler card before working in the booth. People in the booth without a card will be asked to leave and a critical violation will be assessed, requiring a reinspection with accompanying $100.00 fee.
◊
I agree to abide by the law and regulations of the State of Arizona and La Paz County.
◊ I understand that retention of this permit is contingent upon satisfactory compliance with all local and state regulations.
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Licensing Eligibility Required per ARS 41-1080 >>Please attached a copy of identification – both sides of ID.
Check the type of I. D. you will be submitting :
□ AZ driver license issued after 1996 or AZ non-operating I.D. license
□ A driver license issued by a state that verified lawful presence in U. S. (Licenses from HI, IL, ME, MD, NM, TX, UT, and WA are NOT acceptable)
□ A birth certificate issued in any state, territory or possession of the U. S.
□ A U.S. certificate of birth abroad □ A U. S. passport □ A foreign passport with U. S. visa
□ A I-94 form with a photograph □ A U. S. certificate of naturalization □ A U. S. certificate of citizenship
□ A U. S. citizenship and immigration service employment authorization document or refugee travel document
□ A tribal certificate of Indian blood □ A tribal or Bureau of Indian Affairs affidavit of birth
By my signature below, I hereby certify, under penalty of perjury that the copy of the document I am providing is a true and accurate copy of the original document and that I am legally authorized to be present in the United States. I further agree to operate under all requirements of the Arizona Food Code and La Paz County regulations as outlined in the statements above.
Applicant Signature Date
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------------Health Department Use Only Below This Line -----------------
Received Date ____________ Received within 30 days? Yes No
Approval Date ____________ Staff __________ www.lpchd.com
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