Environmental Health Services Moore Street, Suite 121 Gold Beach, OR P:

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Environmental Health Services 94235 Moore Street, Suite 121 Gold Beach, OR 97444 P: 541-247-3387 To: Interested Parties From: Environmental Health Services Date: Jan 01, 2018 Subject: Food Service Facilities Reference: Oregon Health Authority - Licensing for Restaurants / Food Service All parties interested in opening a Food Service Facility in Curry County must obtain operating licenses from the Oregon State Health Division. With this licensing, you are obligated to comply with all rules pertaining to food service, OAR 333-150. In order to obtain a license please refer to steps outlined below. Pre-construction: 1. Obtain land use approval by completing and submitting the Land Use Compatibility Statement to the appropriate planning department. 2. Complete and submit a Plan Review, the approved Land Use Compatibility Statement, and a $580 fee to Curry County. 3. The completed plans will be reviewed for compliance with health division codes and an approval letter will be sent if approved. Construction: 1. The facility is then constructed with the proper building permits. 2. Once the construction is finished the facility can then apply for the operating licenses. If the building is an existing structure, building permits may not be required, and the license application can be submitted. Post-construction: 1. Complete and submit the pre-opening checklist along with the food service license application. 2. An inspector from our office will contact you to arrange for a pre-opening inspection at which at the time the two licenses will be issued. The fees for these licenses are listed on the enclosed fee schedule. For more information, please feel free to call or email: Kent Downs Karin Larsen 541-247-3387 downsk@currych.org larsenk@co.curry.or.us

Establishment ID: Owner ID: For office use only FOOD SERVICE LICENSE APPLICATION RESTAURANT/BED AND BREAKFAST Restaurant Bed & Breakfast (B&B Tourist License also required) New Construction Remodel Change of Ownership Former establishment name: Establishment Name: Establishment Physical Address: Establishment Billing Address: Establishment Phone: Number of seats: Owner/Applicant Name: Individual Corporation Partnership Other: Do you own other establishments licensed by the Health Department? No Yes Name(s): Owner Physical Address: Owner Billing Address: Owner Phone: Owner Cell: Owner Fax: Owner Email: The payment of $ license fee is hereby made for application to operate the above establishment in compliance with all applicable food service regulations. I understand that failure to meet the requirements of the provisions of Oregon Revised Statutes, Chapter 624, and the Administrative Rules, Chapter 333, of the Oregon Health Authority may require denial or revocation of the license. Furthermore, I attest that the information provided on this form is accurate. Signature of Applicant: Date: Mail application and check payable to your local Environmental Health Office at: Curry County 94235 Moore Street, Suite 121 Gold Beach, OR 97444 FOR OFFICE USE ONLY Fee received: Cash Check# Money Order Inspected by: Approved Not Approved Full Svc Limited Svc Date: Date: OHA 34-1 REV 07/12

Environmental Health Services 94235 Moore Street, Suite 121 Gold Beach, OR 97444 P: 541-247-3387 Food Sanitation Rules Online Due to the size of the Food Sanitation rules, we do not include a copy of the entire rule in this packet. The rules may be viewed online at the web address listed below. If you need a printed copy of the rules, we can provide them on request. This information provided by the Food, Pool & Lodging Health and Safety Section of the Office of Public Health Systems. http://www.oregon.gov/oha/ph/healthyenvironments/foodsafety/documents/foodsanitationrulesweb.pdf Food Sanitation Rules On January 1, 2012, the Food Protection Program adopted the 1999 FDA Food Code with Oregon Amendments. These new rules incorporate the latest science-based standards for the regulation of food service facilities. The newest rule revision went into effect September 4, 2012. Food Sanitation Rules Download Options (all files are PDF) Use Adobe Acrobat reader for viewing and printing Acrobat (PDG) files. Adobe Reader is available at http://www.adobe.com/products/acrobat/readstep2.html

Environmental Health Services 94235 Moore Street, Suite 121 Gold Beach, OR 97444 P: 541-247-3387 GENERAL RESTAURANT REQUIREMENTS The following is not a complete list of the rules. Please see the current Food Sanitation Rules for complete information. 1. All new food service establishments, establishments not previously licensed by the Health Department and those not licensed for the preceding 12 months, must comply with all current rules regarding plumbing, construction and equipment. Plans: Submit plans for review and approval before the construction or remodeling of a food service establishment. 2. Hand- Washing Sinks: In establishments constructed or substantially remodeled after July 1965, hand-washing facilities shall be present in the food preparation area and must be easily accessible. HAND-WASHING SINKS MUST BE SEPARATE FROM OTHER SINKS AND MAY NOT BE USED FOR FOOD PREPARATION OR UTENSIL WASHING. 3. Food Preparation Sink: Provide cleanable construction. Hand washing and ware washing is not allowed. Plumb the waste line indirectly. 4. Dishwashing: Dishwashing must be accomplished either by means of a three- compartment sink or by an approved dishwashing machine. In either case, the dishwashing area shall be equipped with drain boards or sorting tables: one for soiled utensils, and one for clean utensils. These surfaces should be sufficient size to handle peak loads in a sanitary manner. Two compartment sinks for dishwashing are not allowed. a. Three-compartment Sinks: Each compartment shall be of sufficient size to allow immersion of the largest utensil to be washed. Each compartment of the sink shall be supplied with hot and cold running water. When possible these must have indirect wastes. b. Mechanical Dishwashing: The pressure of the final sanitizing rinse water supplied to the machine shall not be less than 15 nor more than 25 pounds per square inch (psi) measured in the water line immediately adjacent to the final rinse control valve. A ¼ inch Iron Pipe Size (IPS) valve must be provided immediately upstream from the final rinse water. Machine or water line mounted thermometers, accurate to ±3 F, must be provided to indicate the temperature of the final rinse water as it enters the manifold. Plumb the drain lines with an indirect connection. i. Hot Temperature Type: If the machine sanitizes by means of hot water, it must maintain a minimum wash and rinse temperature as specified by the manufacturer and measured at the dish rack.

ii. Cold Temperature Type: If the machine sanitizes by means of chemical injection, it must maintain a minimum wash temperature of 120 F and a minimum rinse temperature of 75 F or higher if specified by the manufacturer. The concentration of the chemical sanitizer is injected during the final rinse must be at least 50ppm for chlorine types, 12.5ppm for iodine types. An approved test kit to accurately measure the concentration of the chemical sanitizer must be provided and used on a regular basis. 5. Mop Sinks: Installation of a utility sink or curbed cleaning facility is required. Any hose bibs require installation of vacuum breakers. 6. Cold Holding: Enough conveniently located refrigeration facilities or effectively insulated facilities shall be provided to assure the maintenance of potentially hazardous food at required temperatures during storage. Each mechanically refrigerated facility storing potentially hazardous food shall be provided with a numerically scaled spirit stem indicating thermometers accurate to ±3 F, located to measure the air temperature in the warmest part of the facility and located to be easily readable. Recording thermometers, accurate to ±3 F may be used in lieu of indicating thermometers. Refrigerators equipped with a temperature gauge visible from the exterior are acceptable. 7. Rapid Cooling: If perishable food will be cooled then a method to cool this food must be provided. Commercial air cooled refrigerators or ice baths are recommended for this purpose. 8. Hot Holding: Steam tables must maintain hot stored food at a temperature of 140 F or more. If hot holding units do not come equipped with thermometers, obtain a metal stem product thermometer and keep them available to check internal food temperatures. 9. Rapid Reheating: If perishable food will be reheated then it must be reheated to 165 F within one hour. Home style crock-pots and steam tables are not designed for this purpose. 10. Equipment: All equipment should be easily cleanable and in good repair. All metal equipment should be free of rust and corrosion. Rusty/corroded metal equipment should be replaced or refinished in an approved manner. Chipped, painted wooden surfaces must be refinished. All stationary equipment should be installed in a manner providing ease of cleaning beneath or behind the equipment. 11. Indirect Waste: Any piece of equipment utilized to hold food, ice or dishware that is equipped with a drain must waste indirectly to floor drains or floor sinks. The distance between the bottom of the waste pipe and tip of the drain must be at least one inch or two waste pipe diameters. 12. Hoods: As per building and fire regulations.

13. Wall, Floor, and Ceiling Construction: Floors, walls and Ceilings must be finished, smooth and easily cleanable. The use of smooth nonabsorbent, hard materials (Formica, stainless steel, FRP fiber glass reinforced polyethylene, etc.) on the walls behind the dishwashing areas, pot and pan washing areas, mop washing and in any other areas where damage may be done to the walls is highly recommended. Wall/floor, wall/wall and wall/ceiling junctions should be tightly joined and sealed. Coving is recommended for all non-carpeted floors. Carpets may be installed in dining areas only. All gaps, cracks, crevices and holes shall be repaired, filled, sealed and made smooth. Walls and ceiling shall be finished in a light color in food preparation and servicing areas. Enclosed or eliminate utility service lines that prevent easy cleaning of walls or floors. 14. Lighting: Adequate shield lighting must be provided. 15. Doors and Windows: Restroom doors shall be self-closing. Exterior doors shall be rodent proof (clearance should not exceed ¼ inch and should be as tight fitting as possible). All openings to the outer air area to be screened to prevent fly access (includes ventilation ports). 16. Storage Devices: All storage shall be at least 6 inches off the floor to permit cleaning of the floor, except where storage is on a wheeled platform or sealed base. 17. Locker, Dressing Rooms and Break Areas: Adequate storage areas should be provided for employee clothing and personal items. A designated employee s break area for eating, drinking and smoking is required. 18. Garbage Areas: Provide hard, cleanable surfaces of adequate size in these areas. Outside containers must be covered and adequately sized. 19. Toxic Items: Toxic items must be stored, labeled and used to ensure proper use and prevent contamination of food and food preparation surfaces. 20. Clean Indoor Air: Per Oregon State Statute, smoking is not allowed indoors. The ordinance includes bars and taverns, and bar portions of restaurants. 21. Self-Serve: Be aware that all food or food items in the facility, which are within customer reach and are not prepackaged, must be protected from customer contamination by a sneeze shield or other approved means. 22. Operation: DO NOT OPEN FOR BUSINESS UNTIL APPROVED BY CURRY COMMUNITY ENVIRONMENTAL HEALTH. CALL (541) 251-7074 FOR A PREOPENING INSPECTION.

Food Service Plan Review Application New Remodel Name of Establishment: Location Address: Facility Phone: Website Owner: Email: Mailing Address: Daytime/Cell Phone: Contact Person & Title (architect): Email: Mailing Address: Daytime/Cell Phone: Projected start date: Projected date for completion: When submitting this application, include the following documents: Proposed menu(s), including seasonal, off-site and banquet menus Site plan - location of building on site, including alleys, streets and outside equipment (dumpsters, well, septic system) Plan drawn to scale showing location of equipment, plumbing, electricity services and mechanical ventilation List of equipment & specifications I have submitted plans/applications to (or obtained permits from) the necessary or appropriate authorities including zoning, planning, building, plumbing, and fire departments. Yes No Food Plan Review Page 1 34-74 (Rev. 10/15)

Type of Service (Check the food service that best describes your operation): Cook and Serve Cook, Hold Hot and Serve Cook, Chill, Reheat, Hold Hot and Serve Hold Cold and Serve Commercially prepackaged food only (except beverage) Other What are your expected number of meals served per day? What will be the frequency of food delivery? Will food be transported to another location as with a catering operation or satellite kitchen? Yes No Days and Hours of Operation: Number of seats: Inside Outside Number of staff (total): Total square feet of facility: Number of floors on which operations are conducted: Frequency of waste removal? Garbage Recycling (Oil/grease/fat, Cardboard/paper) Composting Water system source and type of sewage disposal (e.g., on-site, city) Submitting incomplete plans will delay the plan review process. Please answer every question that applies to your food service operation. Food Plan Review Page 2 34-74 (Rev. 10/15)

According to OAR 333-150-0000 Required Format and Specifications Draw Plans to Scale 1. Accurately draw floor plan to a minimum scale of ¼ inch = 1 foot 2. Show seating capacity 3. Locate and label each piece of food equipment with its common name Include self-service hot and cold holding units with sneeze guards (Chapter 3 & 4) Indicate if equipment is not newly purchased A direct waste connection may not be used for equipment in which food, or ice is placed (5-402.11) 4. Identify the equipment that will be used for rapid cooling, including ice baths and refrigeration 5. Identify the equipment that will be used for rapid reheating 6. Identify food preparation sinks, including indirect drains 7. Show where raw and ready-to-eat food will be prepared 8. Identify each designated hand sink. This includes hand sinks in the restrooms, food preparation, food service, and dishwashing areas (Chapter 5) 9. Include: a. Entrances, exits, loading/unloading areas and docks b. Plumbing schedule, including location of floor sinks, overhead wastewater lines, water heater BTU or KW and capacity, grease trap or interceptor (Chapter 4 & 5) c. Source of water supply and method of sewage disposal other than a municipal system (Systems must meet state regulations) (Chapter 5) d. Mop sink or curbed cleaning facility with facilities for hanging wet mops (5-203.13) e. Location for storing chemicals (7-201.11) f. Location for the storage of personal items such as dressing rooms, locker areas and employee rest areas (6-305.11) g. Dish (warewashing) machine or 3-compartment sink, including indirect drain (Chapter 4) Largest piece of equipment must be able to fit into sink or dish machine (4-301.12) Indicate if dish machine is chemical or high temperature sanitizing h. Indicate surface materials and the location of where the dumpster, compactor, garbage cans, waste oil, and recycling containers are stored (Chapter 5-501 & 6-102) Food Plan Review Page 3 34-74 (Rev. 10/15)

Interior Finishes/Surfaces OAR 333-150-0000, Section 6-101.11A(3) Use the following chart to indicate all interior finishes or reference number on plans: Floors Cove Base Walls Ceilings Food Contact Surfaces Shelving Kitchen Bar Storage Rooms Toilet rooms Garbage & refuse storage Mop service area Dish washing area Walk-in refrigerators & freezers Example: Kitchen Quarry tile Smooth seal Quarry tile Smooth seal FRP smooth Stainless steel Painted smooth Vinyl acoustical tile Smooth Stainless steel Hardwood cutting surfaces Formica Wood Painted smooth Stainless steel Food Plan Review Page 4 34-74 (Rev. 10/15)

Menu & Procedure Review This section must be filled out by the operator and submitted prior to licensing or with the plan review application. Answer only the questions that apply to your facility. Add documents or pages as needed to describe your operation. The Food Sanitation Rules, OAR 333-150-0000 can be obtained at: www.healthoregon.org/foodsafety Training & Policies 1. Describe your current policy to exclude or restrict food workers who are sick or have infected cuts and lesions (2-201.12): 2. What are employees told about working when ill (2-201.12)? 3. Provide your established hand washing policy (2-301.14, 2-301.13, 2-301.12, 2-301.15): 4. How are employees informed about hand washing requirements (2-103.11(L))? 5. How do you enforce hand washing and ill employee requirements (2-201.12, 2-103.11(D) & (K))? Food Plan Review Page 5 34-74 (Rev. 10/15)

6. Who will be your people in charge (2-101.11)? 7. Are you aware of the rule that requires a knowledgeable person to be present at all times of operation (2-102.11)? Yes No Note: One way to meet this is to obtain certification in a Food Safety Program designed for food managers: www.healthoregon.org/foodsafety 8. List the types of food probe thermometers (0-220 F) that food handlers will be using and where the thermometers will be kept (4-302.12 & 4-203.11)? 9. How do you calibrate your food probe thermometers and how often? Who is responsible for calibrating thermometers (4-502.11(B))? 9a. How do you clean and sanitize your probe thermometer (4-602.11(4))? 10. What type of chemical sanitizer do you use (chlorine, quaternary ammonium, iodine) (4-501.114)? At what concentration do you use this sanitizer? What type of test kit do you have (4-302.14)? When do you use your test kit (4-501.116)? Food Plan Review Page 6 34-74 (Rev. 10/15)

11. Describe how cutting boards, counter tops, equipment and other food contact surfaces that are too big to be submerged into sinks and too big for the dishwasher are cleaned and sanitized (4-603.15)? 11a. When does cleaning and sanitizing need to occur (4-602.11)? 12. What is done with leftover food (Chapter 3-501)? 13. Will salads such as tuna, egg, chicken, macaroni, pasta and potato be prepared from scratch in your facility? Yes No If yes, will the ingredients be pre-chilled before being mixed or assembled? Yes No 14. Describe how you will minimize the handling of ready-to-eat food. For example will you use disposable gloves to prepare ready-to-eat food (2-103.11(K))? 15. Describe when and where produce will be washed prior to use (3-302.15 & 5-402.11): Food Plan Review Page 7 34-74 (Rev. 10/15)

Food Preparation 1. List food from animals that you will serve raw or partially cooked such as sushi, steak tartar, and oyster shooters (3-603.11): 2. If serving raw fish (sushi, lox, ceviche), will parasite destruction be done on-site or by the supplier (3-402.11 & 3-402.12))? On-site Provide your procedure on parasite destruction (A freezer used for parasite destruction must maintain 4 F for 7 days. Measure and record temperature of freezer unit daily.) Supplier Provide the name of your supplier and documentation to show parasite destruction. (Each invoice received from the supplier shall state the specific fish by species that have been frozen to meet the parasite destruction requirements under 3-402.11.) 3. List your food suppliers for the following (Chapter 3, Section 2): Category Supplier(s) Game meats (e.g., emu, ostrich, elk) Raw or partially cooked fish products (e.g., lox, ceviche, raw oyster, sushi) Fresh or live shellfish Wild mushrooms 4. Describe food processing within your facility (smoking meats, sous vide, canning, specialty processing) (Chapter 3-502): Food Plan Review Page 8 34-74 (Rev. 10/15)

Holding Food Temperatures Cold & Hot (Chapter 3-501) 1. Refrigerated food must be maintained at 41 F or colder. How did you determine the amount of cold storage/holding that you will need for your operation (4-301.11)? 2. How will you ensure that each refrigerator has a working thermometer and that the temperature is maintained at 41 F or colder (4-203.12, 4-204.112, 4-502.11)? 3. Refrigerator Units (4-301.11) List size, description/manufacturer, and what will be stored in each: Refrigerator Number Size/capacity Manufacturer or Description Type of food stored inside Note: Add pages as needed 4. Is an ice machine provided and indirectly drained? Yes No (5-402.11) 5. If ice is purchased, who is your supplier? Food Plan Review Page 9 34-74 (Rev. 10/15)

6. If you will be using ice for keeping food cold such as in a salad bar, how should the food be stored in the ice? Please describe: 7. Describe your procedure for date marking of ready-to-eat potentially hazardous food items? 8. How will you store raw animal food to prevent contamination of ready-to-eat food (3-302.11)? 9. How and where will frozen food be thawed (3-501.13)? Note: When storing raw animal products above one another, their storage must be based on the final required cooking temperature of each animal product. The animal product with the lowest cooking temperature must be stored above other raw animal products that require a higher cooking temperature (e.g., raw fish above raw ground beef). 10. What type of equipment will you use for holding food hot? How will you ensure that food is at the required temperature throughout the day? 11. Describe how food temperatures (hot and cold) will be maintained while in transport and at the catered site or satellite kitchen(s)? Note: Required holding temperatures and cooling requirements are listed in the "Food Safety: Your Self-Training Manual" or in the "Food Sanitation Rules" both can be obtained from your local health department or at this website: www.healthoregon.org/foodsafety Food Plan Review Page 10 34-74 (Rev. 10/15)

Cooling 1. In the appropriate box, list menu items of food items that will be cooled. Cooling Method Shallow Pans* Solid Food (roast, turkey, solid cuts of meat) Soft, Thick Food (refried beans, rice, potatoes, stews, soups, sauces & chili) Liquid Food (thin broths) Ice Baths** Reduce Volume or Size Blast Chiller Other (Describe) * Adequate and appropriate refrigeration is required ** Food-preparation sink and ice machine are required 2. How will food handlers know that the food has cooled from 140 F to 70 F within two hours and then from 70 F to 41 F within 4 hours? Food Plan Review Page 11 34-74 (Rev. 10/15)

Cooking & Reheating 1. Describe how the food worker will know when raw animal products are fully cooked (3-401.11): Note: Required cooking temperatures are listed in the "Food Safety: Your Self-Training Manual" or in the "Food Sanitation Rules" both can be obtained from your local health department or at this website: www.healthoregon.org/foodsafety 2. How will the cook know that all parts of the food being reheated has reached at least 165 F for 15 seconds within 2 hours? 3. List type of units used for reheating. Self Service 1. Will you provide self-service food to your customers? Yes No 2. How will you protect food in self-service areas from customer contamination (3-306.11 & 3-306.13)? Food Plan Review Page 12 34-74 (Rev. 10/15)

Food Sanitation Rules OAR 333-150-0000 1. Do you have a copy of the Food Sanitation Rules? Yes No The rules are online at: www.healthoregon.org/foodsafety If you do not have access to the Internet, you can obtain a copy from the Local Public Health Authority. 2. Do you know how to locate specific information in the rules? Yes No 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 Regulatory Office may nullify final approval. Signature(s) of Owner(s) or responsible representative(s): Date Date Date Approval of these plans and specifications by the Regulatory Authority 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 and operational will be necessary to determine if it complies with the Food Sanitation Rules (Oregon Administrative Rules Chapter 333).. Food Plan Review Page 13 34-74 (Rev. 10/15)

Pre-opening Checklist for Operators Answer yes to each item before scheduling a pre-opening inspection Hand-washing facilities 1. Is hot and cold running water available at each handwashing sink? Yes No 2. Are mixing valves, combination faucets or metered faucet provided at each hand-washing sink? Yes No 3. Are metered faucets set for a minimum of 15 seconds? Yes No 4. Are hand cleansers provided for all hand-washing sinks? Yes No 5. Are approved methods for drying hands provided at all hand-washing sinks such as paper towels? Yes No 6. Are covered waste receptacles available in unisex and women's restrooms? Yes No 7. Are all toilet room doors self-closing? Yes No Dishwashing Facilities 1. Do all dish machines have data plates with operating specifications? Yes No 2. Do all dish machines have the required temperature and pressure gauges that are accurately working? Yes No 3. Is your dish machine reaching 160F at the tray level or dispensing 50ppm chlorine residual in the final rinse? Yes No 4. Do you have a procedure for manual cleaning and sanitizing of fixed equipment? Yes No 5. Does the three-compartment sink have a drain board on each end of it? Or alternatives? Yes No Food Plan Review Page 14 34-74 (Rev. 10/15)

Miscellaneous 1. Are all containers of chemicals, including spray bottles, clearly labeled and stored away from food? Yes No 2. Will dry product storage be stored 6 inches off the floor? Yes No 3. Are all food containers made of food grade materials? Yes No 4. Do you have a system for laundering linens or work clothes? Yes No 5. Are all food preparation areas free of carpet? Yes No Insect and Rodent Control 1. Are all outside doors self-closing and rodent proof? Yes No 2. Are screens provided for doors and windows that will be kept open to the outside? Yes No 3. Are all pipes & electrical conduit openings sealed? Is the ventilation system (exhaust and intake) protected? Yes No 4. Is the area around the building clear of unnecessary brush, litter, boxes and other unnecessary items? Yes No 5. Do you have a location and a procedure in place for cleaning garbage cans and floor mats? (Is the drain plumbed to sewer?) Yes No Refrigeration Units 1. Are all refrigeration units operational? Yes No 2. Does each refrigeration unit have a working thermometer? Yes No 3. Is each refrigerator operating at 41F or colder? Yes No 4. Do you have a procedure for date marking? Yes No Food Plan Review Page 15 34-74 (Rev. 10/15)