Truck Regulations City of Fredericksburg, Virginia Community Planning & Building - 540-372-1179 1. Not to be Located within Public Right-of-Way (On the Street). a. Exception: Only permitted in conjunction with a Parks and Recreation Managed Special Event or Farmers Market.

b. Contact Information for Parks and Recreation 408 Canal Street Fredericksburg, VA 22401 Phone: 540-372-1086

Farmers Market – Wendy Stone, Division Manager of Finance & Leisure Services, [email protected]

Special Event – Kim Herbert, Supervisor of Special Events, [email protected]

1. Must be Located on Private Property. a. Only permitted in zoning districts which allow ‘fast-food’. Will need to obtain a Special Use Permit if ‘fast-food’ requires a Special Use Permit.

b. Requires approval of a Site Plan application. Please contact the Planning Department to see if your site(s) have plans already approved.

2. Additional Permitting Required 1. Planning Department. A) A Certificate of Zoning Use is required. There is a $30 fee. See attached application. B) A Site Plans is required. They are either minor or major. Please contact the department to see which you may require. 540-372-1179. 2. Fire Department. Has regulations and requires a Mobile Food Unit Inspection application. See attached application. 540-372-1059

3. The Commissioner of the Revenue. Requires that a business license be obtained and that the food truck be registered for tax payments. See attached applications. Also, please visit https://www.fredericksburgva.gov/305/New- Business-Checklist or call 540-372-1004.

Community Planning and Development. Form updated September 30, 2019. 4. Health Department. Requires four permits: Application for a Mobile Unit permit; Application for a Mobile Food Unit Plan Review; Commissary Authorization; Service Area Authorization. See attached applications. Please call 540-899- 4797 or visit http://www.vdh.virginia.gov/rappahannock/services/food- services/

This document prepared by the City of Fredericksburg Department of Planning and Community Development. Please submit one copy of each completed form along with your Certificate of Zoning Use. The Business License cannot be obtained until after you have received an approved Certificate of Zoning Use.

Community Planning and Development. Form updated September 30, 2019.

City of Fredericksburg Planning Services Division 715 Princess Anne Street, Room 209 P.O. Box 7447, Fredericksburg VA 22404 Tel. 540 372 1179, www.fredericksburgva.gov CERTIFICATE OF ZONING USE PERMIT

This is a: Change of Address / Change of Ownership / New Business/ Other (Fee: $30.00)

Business Name: Bus. Phone: Business Location: Business Mailing Address: __ E-Mail: Description of Business: Start Date: Business Owner Name: E-Mail: Business Owner Mailing Address: Previous use of property: Proposed Use (be specific): No. of off-street parking spaces: Square Footage to be used: Is this property located in the Historic District? Yes ____ No ____ CZU will be issued by the Building Services Department along with an approved Occupancy Permit. This is NOT a Certificate of Occupancy. Approval of an Occupancy Permit and a Zoning Permit must be obtained before a Business License will be issued. How would you like to receive your permit once issued? Circle One: E-Mail / Phone / Mail By signing below you are certifying that the above information is correct and you understand that this permit only applies to the business address noted above. If you move from this location, you will need to apply for a new “Certificate of Zoning Use Permit.” See reverse side of application for additional permit requirements.

Name of Business Owner Date Signature of Business Owner

Name of Property Owner Date Signature of Property Owner

SIGNS PLACED ON THE PROPERTY WILL REQUIRE SUBMITTAL OF A SIGN APPLICATION. THIS APPLICATION ONLY CERTIFIES COMPLIANCE WITH ZONING REGULATIONS.

For Completion by Community Planning & Building Department

Approved Disapproved CZU Permit # ______Fee Paid ______

Zoning Designation: ______If Category is ‘Other’, specify: ______Comments: ______

______Zoning Administrator Date

Copy to: Building ServicesOTHER Division REQUIRED Fire Marshal PERMITS/LICENSES Police (Support Services Division Commander) Commissioner of Revenue Economic Development Form Updated June 11, 2019

CERTIFICATE OF OCCUPANCY PERMIT

A Certificate of Occupancy is required for all new businesses occupying a commercial space within the City. An application can be obtained in the Building Services Division, City Hall, Room L6, Lower Level. If you have any questions, please contact us at 540-372-1080.

BUILDING PERMITS

To build a new building or structure, make additions and/or alterations, or change the use of an existing building requires a Building Permit from the Building Services Division, City Hall Room L6, Lower Level. All work proposed within the Historic District requires a Certificate of Appropriateness from the Architectural Board before a permit will be issued.

Anyone with questions concerning the Building Permit process, whether a building permit would be required, information about permit fees, or applicable Building Code regulations may contact the Building Official or the Deputy Director for Building Services Division, 540-372-1080.

SIGN PERMIT

A Sign Permit is required for all signs erected or placed on property or buildings in the City. Applications may be obtained in the Community Planning & Building Department, City Hall, Room 209, 540-372-1179. All signs proposed for property in the Historic District require a Certificate of Appropriateness from the Architectural Review Board before a sign permit will be issued. In addition all portable signs displayed in the Historic District require a Portable Sign Permit.

BUSINESS LICENSE

A Business License is required for anyone wishing to operate a business within the City. A Business License Application can be obtained in the Commissioner of Revenue’s office, Room 102, City Hall, 540-372-1004. Approval of an Occupancy Permit and a Zoning Permit must be obtained before a Business License will be issued.

FENCE/WALL PERMIT

Construction of a wall or fence taller than 6 feet will require a building permit. Applications may be obtained in the Community Planning & Building Department, City Hall, Room 209, 540-372-1179. All work proposed within the Historic District requires a Certificate of Appropriateness from the Architectural Board before a permit will be issued.

SIDEWALK CAFÉ LICENSE

Restaurants in the Historic District with outside seating require a Sidewalk Café License. Applications are available in the Community Planning & Building Department, City Hall, Room 209, 540-372-1179.

FOR ADDITIONAL INFORMATION

Architectural Review Board, City Hall, Room 209, 540-372-1179 Commissioner of the Revenue, City Hall, Room 102, 540-372-1004 Building Services Division, City Hall, Room L6, 540-372-1080

Lois B. Jacob City of Fredericksburg Commissioner of the Revenue 715 Princess Anne Street Telephone: 540-372-1004 P. O. Box 644 Fax: 540-372-1197 Fredericksburg, VA 22404-0644

Year______Acct#______BUSINESS LICENSE APPLICATION

Federal ID Number/Social Security Number (must provide copy of FEIN letter from IRS) Type of Ownership ␀ Sole Proprietor ␀ Corporation*(see below) ␀ LLC*(see below) ␀ Partnership (must provide copy of Certificate of Incorporation/Organization from State Corporation Commission)

Trade Name

Incorporated Name (if corporation or LLC, list name as it appears on Certificate from the State Corporation Commission)

Mailing Address City, State, Zip

Owner’s Name

Home Address of Owner City, State, Zip

Business Location

Contact Phone Business Phone

If Sales/Excise Tax is collected, who is responsible person?

Detailed Description of All Proposed Business Activity

Date Applicant Will Begin Business in the City

Estimated GROSS Receipts at City location for current year (until December 31)

Signature of Owner Title Date

Print Name of Owner

Email address

*Complete if incorporated or an LLC registered with the State Corporation Commission Address of Principal Corporate Office State of Incorporation/Organization Date of Charter Date of Qualification in Virginia if a Foreign Corporation

Name of Registered Agent Address of Registered Agent ************************************************************************************************** *** For Office Use Only □ Zoning Approval or Waiver Required Dst______□ Occupancy Permit or Waiver Required ABC#______□ Clerk of Circuit Court (Registration of fictitious name ($10.00) Sales Tax #______

Code Rate License Tax Code Rate License Tax Flat Fee Flat Fee Flat Fee Flat Fee

Deputy THIS LICENSE EXPIRES DECEMBER 31, ANNUALLY Rev. 1/2015 ADDITIONAL INSTRUCTIONS

New businesses open less than 12 months, please provide the prior year actual gross receipts and the current year estimated gross receipts. Established businesses should report prior year gross receipts.

Your business must be properly zoned before you begin operating. (Zoning # 540-372-1179) All fictitious names must be registered with the Clerk of the Circuit Court. (Clerk # 540-372-1066)

BUSINESSES WITH LESS THAN $100,000 OF GROSS RECEIPTS

If the gross receipts for any license category (except coin-operated machines**) are less than $100,000, you will pay a license fee of $25 per category to obtain a business license. Any flat rate taxes for the sale of alcohol or tobacco are in addition to the license fee.

LICENSE RATES ON GROSS RECEIPTS BETWEEN $100,000 AND $350,000 (in addition to license fee of $50.00) Wholesale merchants ...... $.05/$100 of gross receipts over $100,000 Construction contractors ...... $.16/$100 of gross receipts over $100,000 Retail sales of motor vehicles and vehicle fuel ...... $.19/$100 of gross receipts over $100,000 Retail sales, including ...... $.20/$100 of gross receipts over $100,000 Motor vehicle repair ...... $.26/$100 of gross receipts over $100,000 Commission merchants ...... $.36/$100 of gross receipts over $100,000 Services-repair, personal, business and all other ...... $.36/$100 of gross receipts over $100,000 Financial services ...... $.46/$100 of gross receipts over $100,000 Professional and real estate services ...... $.58/$100 of gross receipts over $100,000

LICENSE RATES ON GROSS RECEIPTS OVER $350,000 (license fee does not apply) Wholesale merchants ...... $.05/$100 of total gross receipts Construction contractors ...... $.16/$100 of total gross receipts Retail sales of motor vehicles and vehicle fuel ...... $.19/$100 of total gross receipts Retail sales, including restaurants & caterers ...... $.20/$100 of total gross receipts Motor vehicle repair ...... $.26/$100 of total gross receipts Commission merchants ...... $.36/$100 of total gross receipts Services-repair, personal, business and all other ...... $.36/$100 of total gross receipts Financial services ...... $.46/$100 of total gross receipts Professional and real estate services ...... $.58/$100 of total gross receipts

**Coin-operated machines are taxed at $0.26 per $100 of gross receipts actually received from any coin-operated machine or device except those machines that vend goods, wares and merchandise, postage stamps or delivery of newspapers.

FLAT RATES

Sale of mixed beverages (restaurants – based on seating capacity)* 50-100 = $100* 100-150 = $175* 150 and over = $250* Non-profit clubs = $175* Sale of beer for on-premise consumption ...... $30* Sale of beer for off-premise consumption ...... $25* Sale of wine for on-premise consumption ...... $20* Sale of wine for off-premise consumption ...... $25* Sale of any tobacco products ...... $20* Itinerate merchants and/or Peddlers ...... $200 per calendar year

*In addition to gross receipts tax; all alcohol sales must still be included in gross receipts

Contact the Office of the Commissioner of the Revenue with any questions 540-372-1004

Lois B. Jacob City of Fredericksburg Commissioner of the Revenue 715 Princess Anne Street P. O. Box 644 Fredericksburg, VA 22404-0644 Telephone: 540 372-1004 Fax: 540 372-1197

MEALS TAX REGISTRATION

Please print out to complete, sign, and submit

Federal Identification Number:______

1. Name of Business ______(trade name) 2. Owner ______(name of individual, partnership or corporation that owns the business) 3. Location of Business ______(street and number) 4. Class ______(, , deli, bar, drive-in, etc.) 5. Mailing Address ______(when address is different from 3 above) 6. Telephone Number ______

7. Types of Ownership ______(individual, partnership, corporation) 8. Name of Officials Signing if Corporation ______

9. Date Started , or to Start at This Location ______

10. Name of Business Succeeded ______

Date ______

______(Print Name Here)

______(Sign Name Here)

______(Title) Commonwealth of Virginia

Application for a Mobile Food Unit

Application for a: ___New Mobile Unit___ Permit Renewal ___Name Change ___Change of Owner

Establishment Information: Name of Establishment:______Physical Address (include zipcode):______Mailing Address (if different): ______Phone:______

Establishment Owner Information: Legal Owner Type: Association__ Corporation __ Individual __ Partnership _ Other ___ Association, Corporation Partnership Name: ______If a Corporation or LLC, please attach list of owners, addresses and phone numbers. Legal Owner Name:______Owner Billing Address:______Local Registered Agent (if required): ______Title: ______Local Agent’s address: ______

Applicant Contact Information: Applicant's Name:______Title: ______Telephone:______Cell ______Fax ______

Service Area Name: ______Phone:______Address:______(Attach letter from the service area authorizing use of the establishment)

Selling Location(s): 1.______2.______

3.______4.______

Hours of Operation: ______

Days of Operation (Check all that apply): __Sun __M __T __W __Th __F __Sat

Approximate Months of Operation: ______

License Plate Number for Cart or Truck:______

Will this mobile unit (circle Yes or No):

1. Prepare, offer for sale, or serve that require temperature control for safety (meats, cheese, soups, sauces, , cooked vegetables, sliced fruit)? Yes No a. Only to order upon a consumer’s request? Yes No b. In advance in quantities? Yes No

2. Place food out at normal room temperature for a set period of time? Yes No

3. Prepare potentially hazardous food in advance using a food preparation method that involves 2 or more steps which may include combing temperature control for safety (TCS) ingredients, cooking, cooling, reheating, hot or cold holding, freezing or thawing? Yes No

4. Does not prepare but offers for sale only prepackaged food that do not require temperature control for safety? Yes No

5. Prepares only food that does not require temperature control for safety? Yes No

The water supply for use in the unit is? Public _____ Private _____ (if private attach copy of written approval)

How will the wastewater be removed from the unit? ______

I/we attest to the accuracy of the information provided, affirm to comply with the Commonwealth of Virginia Food Regulations and allow the regulatory authority access to the establishment at any reasonable time to inspect, conduct tests or collect samples as required.

Signature: ______Title: ______Date: ______

Mail the application and remit $40 fee to: Fredericksburg Health Department Attn: Environmental Health 608 Jackson Street Fredericksburg, VA 22401

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Application for Mobile Food Establishment Plan Review Virginia Department of Health Rappahannock Area Health District Fredericksburg City, Caroline, King George, Spotsylvania, and Stafford Counties

Date:______Mobile Food Establishment Type: Mobile unit_____ Pushcart ____ Vending Truck______

Establishment Information: Name of Establishment:______Physical Address (include zipcode):______Mailing Address (if different): ______Phone:______

Establishment Owner Information: Legal Owner Type: Association__ Corporation __ Individual __ Partnership __ Other ___ Association, Corporation Partnership Name: ______If a Corporation or LLC, please attach list of owners, addresses and phone numbers. Legal Owner Name:______Owner Billing Address:______

Applicant Contact Information: Applicant's Name:______Title: ______Telephone:______Cell ______Fax ______

I have submitted plans/applications to the following authorities on the following dates: ___Zoning ___Fire

___ Police ___DMV

___Commissioner of Revenue

Hours of Operation: Sun _____ Mon _____ Tues _____ Wed _____ Thurs _____ Fri _____ Sat ______Number of Staff:______(Maximum per shift) Maximum Meals to be Served: Breakfast______Lunch ______Dinner ______Projected Food Operation Start Date:______

Approximate Months of Operation:______

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Please enclose the following documents:

_____ Certified Food Protection Manager credential(s) _____ Proposed (including seasonal, off-site and ) _____ Manufacturer Specification sheets for each piece of equipment _____ Plan drawn to scale of food establishment showing location of equipment, plumbing, and mechanical ventilation

Contents And Format Of Plans And Specifications

1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor plan accurately drawn to a minimum scale of 1/4 inch = 1 foot. 2. Include: proposed menu and projected daily volume for food service operations. 3. Show the location and when requested, elevated drawings of all food equipment. Each piece of equipment must be clearly labeled on the plan with its common name. 4. Designate clearly on the plan equipment for refrigeration, and hot-holding potentially hazardous foods. 5. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross-contamination of raw and ready-to-eat foods. 6. Clearly designate adequate handwashing lavatories in the immediate area of food preparation. 7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment on the floor plan. 8. Include and provide specifications for: a. Complete finish schedule including floors, walls, ceilings and coved juncture bases; b. Plumbing schedule including location of floor drains, floor sinks, water supply lines, overhead waste-water lines, hot water generating equipment with capacity and recovery rate, backflow prevention, and wastewater line connections; c. Lighting schedule with protectors; (1) At least 540 lux (50 foot candles) at a surface where a food employee is working with food or working with utensils or equipment. d. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified for sanitation by an ANSI or NSF accredited certification program (when applicable). e. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with. (1) If proposed commissary or service area is on private well and septic system, obtain written well and septic approval for use from local health department. The local health department will evaluate the proposed commissary or service area dump site to ensure the design of the septic system can handle the proposed volume and strength of the waste water from your unit. This will be based on your menu and an evaluation of the potential daily volume of wastewater. 9. Applicant is responsible for obtaining any required approvals from other agencies, such as zoning/planning, business license, building, city or county authorities and the Department of Motor Vehicle registration/license as applicable.

Note: If mobile unit is vending only prepackaged non-temperature control for safety foods, a permit is not required; however, an application with description of proposed operation is needed. If vending potentially hazardous foods, an application and permit is required.

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Please circle/answer the following questions Food Preparation Review: Check categories of Temperature Control for Safety (TCS) foods to be handled, prepared and served. Category: YES NO 1. Thin meats, poultry, fish, eggs (; sliced meats; fillets) ______2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) ______3. Cold processed foods (, , vegetables) ______4. Hot processed foods (soups, stews, rice, noodles, gravy, casseroles) ______5. Bakery goods (pies, custards, cream fillings & toppings) ______

Food Supplies: Are all food supplies from inspected and approved sources? YES NO Please list all your food suppliers:______

Cold Storage: 1. Is adequate and approved freezer and refrigeration available to store frozen foods frozen and refrigerated foods at 41°F (5°C) and below? YES NO 2. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked/ready- to-eat foods? YES NO 3. If yes, how will cross-contamination be prevented? ______4. Does each refrigerator/freezer have a thermometer? YES NO 5. Number of refrigeration units: _____ 6. Number of freezer units: _____ 7. Is there a bulk ice machine available? YES NO

Thawing Frozen Temperature Control for Safety Foods: Please indicate by checking the appropriate boxes how frozen temperature control for safety (TCS) foods (PHF's) in each category will be thawed. More than one method may apply. Also, indicate where thawing will take place.

Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS Refrigeration Running Water Less than 70°F(21°C) Microwave (as part of cooking process) Cooked from Frozen state Other (describe) *Frozen foods: approximately one inch or less = thin, and more than an inch = thick.

Cooking: 1. Will food product thermometers be used to measure final cooking/reheating temperatures of TCS foods? YES NO

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2. What type of temperature measuring device:______Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: beef roasts 130°F (121 min) solid seafood pieces 145°F (15 sec) other TCS foods 145°F (15 sec) eggs – immediate service 145°F (15 sec) eggs – holding 155°F (15 sec) pork 145°F (15 sec) comminuted meats/fish 155°F (15 sec) poultry 165°F (15 sec) reheated TCS foods 165°F (15 sec) 3. List types of cooking equipment. ______4. Will you be serving any raw or undercooked foods? YES NO If yes, will you have a consumer advisory on your menu? YES NO

Hot/Cold Holding: 1. How will hot TCS foods be maintained at 135°F (60°C) or above during holding for service? Indicate type and number of hot holding units. ______2. How will cold TCS foods be maintained at 41°F (5°C) or below during holding for service? Indicate type and number of cold holding units. ______

Cooling: Please indicate by checking the appropriate boxes how TCS foods will be cooled to 41°F (5°C) within 6 hours (135°F to 70°F in 2 hours and 70°F to 41°F in 4 hours). Also, indicate where the cooling will take place.

COOLING METHOD THICK THIN THIN THICK RICE/ MEATS MEATS SOUPS/ SOUPS/ NOODLES GRAVY GRAVY Shallow Pans Ice Baths Reduce Volume or Size Other (describe)

Reheating: 1. How will TCS foods that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used for reheating foods. ______2. How will reheating food to 165°F for hot holding be done rapidly (within 2 hours)? ______

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Preparation: 1. Please list categories of foods prepared more than 12 hours in advance of service. ______2. Will food employees be trained in good food sanitation practices? YES NO a. Method of training: ______b. Number(s) of employees:______c. Dates of completion:______3. Will disposable gloves, utensils and/or food grade paper be used to prevent bare hand contact with ready-to-eat foods? YES NO 4. Is there a policy to exclude or restrict food workers who are sick or have infected cuts and lesions? YES NO a. If yes, please describe briefly or attach the written policy: ______b. If no, a policy is required prior to opening the facility.

5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks be sanitized? a. Chemical Type: ______b. Concentration: ______c. Test Kit: YES NO 6. Will ingredients for cold ready-to-eat foods such as tuna, mayonnaise, eggs for salads and sandwiches be pre-chilled before being mixed and/or assembled? YES NO If not, how will ready-to-eat foods be cooled to 41°F?______7. Will all produce be washed on-site prior to use? YES NO 8. Is there a planned location used for washing produce? YES NO Describe______If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. ______9. Describe the procedure used for minimizing the length of time TCS foods will be kept in the temperature danger zone (41°F - 135°F) during preparation. ______

A. Finish Schedule Please indicate which materials (quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas.

FLOOR COVING WALLS CEILING Mobile Unit

Page 6 of 8

B. Insect And Rodent Control 1. Are screen doors provided on all entrances left open to the outside? YES NO NA 2. Do all openable windows have a minimum #16 mesh screening? YES NO NA

C. Garbage And Refuse Do all containers have lids? YES NO NA

D. Plumbing Connections Please check where appropriate AIR AIR *INTEGRAL *"P" VACUUM CONDENSATE GAP TRAP TRAP BREAKER PUMP Ice machines Ice storage bin Sinks : Handwash 3 Compartment 2 Compartment Steam tables Dipper wells Refrigeration condensate/ drain lines

Hose connection Beverage Dispenser w/ carbonator Other ______

* TRAP: A fitting or device which provides a liquid seal to prevent the emission of sewer gases without materially affecting the flow of sewage or waste water through it. An integral trap is one that is built directly into the fixture, e.g., a toilet fixture. A “P” trap is a fixture trap that provides a liquid seal in the shape of the letter “P”. Full “S” traps are prohibited.

E. Water Supply 1. Is water supply public ( ) or private ( ) for use in the unit? If private, has source been approved? YES NO PENDING Please attach copy of written approval and/or permit. 2. Is ice made on premises ( ) or purchased commercially ( )? a. If made on premise, are specifications for the ice machine provided? YES NO b. Describe provision for ice scoop storage:______c. Provide location of ice maker or bagging operation______3. What is the size of the fresh water storage tank? ______4. Is the water tank inlet ¾ inches in inner diameter or less? YES NO 5. Is a potable water (food grade) hose available for filling the water tank? YES NO 6. What is the capacity of the hot water generator? ______7. Is the hot water generator sufficient for the needs of the establishment? ______8. How are the backflow prevention devices inspected & serviced? ______

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F. Sewage Disposal 1. How will wastewater be removed from the unit? ______2. What is the size of your wastewater storage tank? ______Note: waste water tank must be sized a minimum of 15% larger than the portable water tank. 3. Do you have a written agreement, signed by owner, of proposed commissary or service area for discharging liquid or solid waste? YES NO

G. Employee Belongings Describe storage facilities for employees' personal belongings (i.e., purses, coats, personal medication, etc.) ______

H. General 1. Will insecticides/rodenticides be stored separately from cleaning & sanitizing agents? YES NO Indicate location:______2. Who will be applying your insecticides/rodenticides?______3. Will all insecticides/rodenticides for use on the premise (this includes personal medications) be stored away from food preparation and storage areas? YES NO 4. Will all containers of toxics including sanitizing spray bottles clearly labeled? YES NO 5. Will food storage containers be constructed of safe, durable, and nonabsorbent materials? YES NO Indicate type: ______6. How each is listed ventilation hood system cleaned? Frequency of cleaning? ______

J. Dishwashing Facilities 1. Does the largest pot and pan fit into each compartment of the 3 compartment sink? YES NO If no, what is the procedure for manual cleaning and sanitizing? ______2. Are there drain boards on both ends of the 3 compartment sink? YES NO 3. What type of sanitizer is used? a. Chlorine ( ) b. Iodine ( ) c. Quaternary ammonium ( ) 4. Are test papers and/or kits available for checking sanitizer concentration? YES NO

K. Handwashing Facilities 1. Is there a handwashing sink in the food preparation area? YES NO 2. Do all handwashing sinks have a mixing valve/combination faucet? YES NO 3. Is hand cleanser available at all handwashing sinks? YES NO 4. Is hot and cold running water under pressure available at each handwashing sink? YES NO 5. Are handwashing signs posted at all hand sinks used by employees? YES NO

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L. Small Equipment Requirements Please specify the number, location, and types of each of the following: a. Slicers ______b. Cutting boards ______c. Can openers ______d. Mixers ______e. Other ______

************ STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from this Health Department may nullify final approval. Signature(s): ______owner(s) or responsible representative(s) Date: ______

************ Approval of these plans and specifications by this Health Department does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A pre- opening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with the local and state laws governing food service establishments. In addition, a Foodservice Establishment Permit Application and fee is required before an operational permit can be issued.

Revised 2/13

$40.00 Plan Review Fee is required For Official Use: Use: Items Submitted in Packet

Make Checks Payable to: ___ Plan Review fee of $40 Fredericksburg Health Department ___ Permit Application with $40 fee 608 Jackson Street ___ Proposed Menu Fredericksburg, Virginia 22401 ___ Manufacturer Specifications for equipment ___ Plan drawn to scale ___ Commissary or Service Area Letter

Plans Reviewed and Approved EHS: ______Date: ______Commissary Authorization Annual Renewal Required

YEAR: ______This serves to notify the Rappahannock Health District that:

I, the owner/operator of the food facility noted below, will allow my facility to serve as a commissary for the mobile food establishment noted below. I understand that as a commissary for the mobile food establishment, I must allow the mobile food establishment to return for servicing on a daily basis. I understand that by signing this form my facility will be inspected periodically by the local health department to ensure the requirements are met.

Name of Commissary

Address of Commissary

Name of Owner/Operator

Days/Hours of Operation

Day Phone E-mail Address

Commissary Water Supply __Public __Private Commissary Sewage __Public ___Private Disposal Name of Mobile Food Establishment Name of Mobile Food Establishment Owner/Operator

The following services are provided for the Mobile Food Establishment by my Virginia Department of Health or VDACS regulated food facility serving as commissary:

1. Adequate space for storage for food, utensils, 5. A food preparation area for mobile food establishment and other supplies. Storage area shall be separated that conducts food preparation. Food preparation area from the food facility’s food, utensils, and other shall be separated from that of food facility or preparation items. Storage areas for the mobile establishment will be completed at alternate time of day. will be clearly marked.

2. Potable water for filling water tanks. 6. Sanitary disposal or waste water and grease. 3. A three compartment sink for sanitizing utensils. 7. Disposal of garbage and refuse. 4. Hot and cold water under pressure for cleaning. 8. Storage of vehicle/cart.

______

Signature of Commissary Operator Print Name Date

I, the owner or operator of the mobile food establishment noted above agrees to use this food facility as a commissary for servicing on a daily basis. I will use the commissary for the requirements noted above. If I do not use the commissary, my Virginia Department of Health food-service permit may be revoked, and I must stop operating until I obtain another commissary and provide a new commissary authorization document to the Local Health Department.

______

Signature of Mobile Food Establishment Owner/Operator Print Name Date Service Area Authorization Annual Renewal Required

YEAR: ______This serves to notify the Rappahannock Health District that:

I, the owner/operator of the food facility noted below, will allow my facility to serve as a service area for the mobile food establishment noted below. I understand that as a Service Area for the mobile food establishment, I must allow the mobile food establishment to return for servicing on a daily basis. I understand that by signing this form my facility will be inspected periodically by the local health department to ensure the requirements are met.

Name of Service Area

Address of Service Area

Name of Owner/Operator

Days/Hours of Operation

Day Phone E-mail Address

Service Area Water Supply __Public __Private Service Area Sewage __Public ___Private Disposal Name of Mobile Food Establishment Name of Mobile Food Establishment Owner/Operator

The following services are provided for the Mobile Food Establishment by my facility:

1 Sanitary disposal of waste water and grease. 3. Disposal of garbage and refuse.

2. Potable water for filling water tanks. 4. Hot and cold water under pressure for cleaning.

______

Signature of Service Area Operator Print Name Date

I, the owner or operator of the mobile food establishment noted above agrees to use this food facility as a service area for servicing on a daily basis. I will use the service area for the requirements noted above. If I do not use the service area, my Virginia Department of Health food-service permit may be revoked, and I must stop operating until I obtain another service area and provide a new service area authorization document to the Local Health Department.

______

Signature of Mobile Food Establishment Owner/Operator Print Name Date