KLAMATH COUNTY
MOBILE FOOD UNIT CHANGE OF OWNERSHIP
FORM
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Name of Business: |
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Name
of Operator: |
(Individual) (Corporation) |
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Class
of Mobile Unit: |
Class I |
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Class II |
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Class III |
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Class IV |
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Unit previously licensed in
State of Oregon: |
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Yes |
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No |
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(If the unit was not previously licensed in the State of Oregon, a plan review must be submitted) |
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County mobile unit was
licensed in: |
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Name of business it was
licensed under: |
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License or Facility number: |
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Year unit was last licensed for: |
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Class
unit was license for: |
Class I |
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Class II |
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Class III |
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Class IV |
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(If the previous license cannot be verified, the mobile unit has been remodeled, or the class of mobile unit is changed, a plan review must be submitted) |
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List all menu items
(including condiments, attach menu if available): |
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Where will food be
purchased? |
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Where will food and/or
single use items be stored? (If all items will not be stored on the unit, a
warehouse or commissary will be required.) |
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Describe how and where
foods will be cooked and prepared. Will any foods be prepared in advance? If
so, please describe: |
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Describe how and where
leftover foods will be cooled and stored for next day’s use: |
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Leftover foods will be: |
Discarded daily |
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Cooled and stored for next day |
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Describe how and where
dishes and utensils will be washed: |
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Describe how surfaces will be sanitized during
operations on unit: |
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Name/Address and Location
of Commissary (submit signed commissary agreement with application): |
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Name/Address and Location
of Warehouse (submit a warehouse license fee if the location is not a
licensed facility): |
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What is the source of water
for the potable water tank on the unit? |
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How will wastewater be
removed from the unit? Describe how wastewater will be transported from the
unit to the approved wastewater disposal location: |
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Describe how handwashing will
be done on unit: (A minimum of five gallons must be provided for
handwashing.) |
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Describe how garbage will
be stored and where it will be thrown away: |
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Where is the restroom
facility for employees located? |
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Describe the type of
overhead protection provided for your unit (ceilings, awnings, umbrellas,
etc.)? |
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Food handler cards are required
for all persons working in a mobile food unit, at the commissary or at the
warehouse. Klamath County Environmental Health must approve any changes in
menu, structure or operations. This mobile unit and its operations must meet
all the requirements applicable to mobile units in the Oregon Revised Statutes,
Chapter 624 and the Oregon Administrative Rules, Chapter 333. This mobile unit
must meet all local plumbing, electrical, building, fire or other codes that
may be required. Health department approval does not imply that your unit meets
other agency codes. All information contained in this record is public.
A pre-opening inspection must be conducted before the
mobile unit may operate or for a license to be issued. Please call (541)
883-1122 to make an appointment for an inspection or if you have any questions.
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Mobile unit licensee signature: |
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Date: |
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Print Name: |
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For Office Use Only |
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Approved by: |
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Date: |
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Facility #: |
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