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FOOD ESTABLISHMENT PLAN REVIEW PROCESS Goldendale Office Klickitat County Health Department White Salmon Office 115 W. Court St 501 NE Washington St/ PO Box 159 Box 103 White Salmon, WA 98672 Goldendale, WA 98620 [PHONE REDACTED] [PHONE REDACTED] Facility Name: Use this checklist to prepare a complete plan review application. Ensure to submit a completed plan review packet(s) and checklist with the required plan review fee. Item Description KCHD Use Only 1 Water Verification Provide proof that the facility is connected to an approved water system. 2 Sewer/Septic Verification Provide proof that the facility is connected to an approved sewer or septic system. 3 Application Provide a complete application. 5 Floor Plan Provide a floor plan of your facility. Floor plan must show locations of all equipment, restrooms, storage areas, etc. 6 Equipment List Provide a list off all large equipment being used for your operation. 7 Finish List Provide a list of the type of material used to finish walls, ceilings, floors, and counter tops. 8 Menu Provide a detailed menu of all food and beverages you will serving or a list of food and beverages you will be selling. Try to include any seasonal items or specials. 9 Food Sources Provide a list of all food and beverage suppliers. 10 Personnel Hygiene Include policies for hand washing, ill food workers, and prevention of bare hand contact 11 Cleaning and Sanitation Provide written procedures describing the type and concentration of sanitizer used, how you intend to clean equipment (including CIP equipment) 12 Food Preparation Steps Provide a description of how each menu item will be prepared. 13 Waste Disposal Provide a method of waste disposal. 14 Fees Include your plan review fee and operation fee. For Mobile Units Please provide commissary information on separate sheet. 15 Commissary Kitchen Agreement Provide a commissary agreement. 16 Sales Site Agreement Provide a sales site agreement for mobile stops. 17 Labor and Industries Approval Provide a copy of your L&I approval. 18 Commissary Items ☐ Floor Plan ☐ Additional Equipment (if any) ☐ Additional Water / Sewer agreements (if any) I understand I cannot open this food establishment until I have received written approval from Klickitat County Health Department. Signature: Date: Please continue to the next page.