Form Ehsd0087C PDF Details

Ehsd0087C is a new form that the Environmental Protection Agency (EPA) has released to help facilities comply with the Formaldehyde Emission Standards for Composite Wood Products rule. The rule, which was published in the Federal Register on April 6, goes into effect on July 6. The form must be submitted to the EPA within 30 days of product manufacture. Ehsd0087c is an important document for any facility that manufactures composite wood products. The form will help facilities track their emissions and ensure they are in compliance with the new rule. Failure to submit the form could lead to civil penalties from the EPA. The form can be downloaded from epa.gov or accessed through the agency's e-filing system, www.airnet.epa.gov . Completed forms should be sent to: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Program Compliance Division (rad), 7601 Cameron Road, Suite A-350, Austin, TX 78752-4363.

QuestionAnswer
Form NameForm Ehsd0087C
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesEHSD0087C stony brook university food safety permit form

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STONY BROOK UNIVERSITY

Environmental Health & Safety

110 Suffolk Hall, Stony Brook, NY 11794-6200

Phone: 2-9683 Fax: 2-9683 Zip: 6200

www.stonybrook.edu/ehs

FOOD PERMIT

Instructions: Please read EH&S Policy 1-15, Food Safety, before completing this application. The policy is on EH&S’ website.

 

 

 

 

 

EVENT & CONTACT INFORMATION

Organization’s Name:

 

Filing Date to EH&S:

 

Food Coordinator:

 

Phone No.:

 

Campus Address:

 

FAX:

 

Name of Event:

 

Event Date:

 

Location of Event:

 

Time Food to be Delivered:

 

Approximate Number of Attendees:

 

Event Hours:

 

 

 

 

 

TYPE OF EVENT

□Campus Community Event

An event that is only open to the campus community (student, faculty and staff) and their invited guests only.

Instructions:

Food Coordinator’s must fully complete and submit this food permit application to EH&S at least 10 days prior to the event.

 

FOOD ESTABLISHMENT/SOURCE

Name:

 

 

 

 

Address:

 

 

 

 

Contact Name/Phone No:

 

 

 

 

Permit Number:

 

 

 

Expiration Date:

Does the Food Establishment

have ‘Off-Premises Catering’ on their permit? Yes

No

Distance of Food Establishment from University: within 10 miles

 

greater than 10 miles

 

 

 

 

 

 

 

 

 

 

FOOD SAFETY

List the foods you will be serving at the event. Be specific.

How will the food be transported and temperatures (Hot Food >140°F/Cold Food <41°F) maintained furing deliver?

Will any food praparation or cooking be performed on campus? □ Yes □ No Note: Food must be prapared in a permitted facility only. Additional permits and/or arrangements will be required, if cooking on campus.

Who will be serving the food (caterer, self serve, sponsoring group)?

How will safw food temperatures (Hot Food >140°F/Cold Food <41°F) maintained during the event? Type of equipment?

 

 

Identify equipment that you will provide and utlize to ensure safe handling:

 

 

 

□ Disposable gloves

□ Food thermometer

□Handwashin g location:___________

 

 

□ Aprons

□ Serving utensils

□ Other:________________________

 

 

 

Hair nets or hats

□ Disposable utensils

 

 

 

 

□

 

 

 

 

Signature of Food Coordinator:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EH&S APPROVAL AND AUTHORIZATION

 

 

 

 

□ APPROVED

 

□ DISAPPROVED

 

 

 

Your application for a food permit has been approed. The Food

FOOD MAY NOT BE SERVED AT THIS EVENT!

 

 

Coordinator is responsible for ensuring the safe handling of food

Your application for a good permit has been disapproved for

 

 

in accordance with this Food Permit and EH&S Policy 1-15. The

reasons noted below.

 

 

 

 

temmperature of food shall be taken and recorded on the Food

□ Lack of information

□ Transport

 

 

Temperature Recording Chart upon its arrival and at 30 minute

□ Food establishment

□ Handling

 

 

 

intercals. All food must be discarded after 2 hours.

□ Type of food

□ Other:___

 

 

 

 

 

 

 

EH&S Comments:

Reviewed by:

Phone:

Date:

EH&S Policy 1-15, Food Safety – Revised April, 2010

EHSD0087C (04/10) THIS PERMIT MUSTBE POSTED AT THE FOOD EVENT www.stonybrook.edu/ehs

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Pay close attention when filling out this document. Ensure that all mandatory fields are filled in properly.

1. It's essential to complete the Form Ehsd0087C accurately, therefore pay close attention when filling in the sections that contain all these fields:

Filling in part 1 of Form Ehsd0087C

2. Soon after performing the previous part, go to the subsequent part and enter the necessary particulars in all these blank fields - How will the food be transported, Will any food praparation or, How will safw food temperatures, Identify equipment that you will, Signature of Food Coordinator, APPROVED, EHS APPROVAL AND AUTHORIZATION, DISAPPROVED, Your application for a food permit, temmperature of food shall be, intercals All food must be, FOOD MAY NOT BE SERVED AT THIS, Your application for a good permit, reasons noted below, and Lack of information Transport.

Filling in part 2 in Form Ehsd0087C

3. This next part is about intercals All food must be, Lack of information Transport, EHS Comments, Reviewed by, Phone, Date, EHS Policy Food Safety Revised, EHSDC wwwstonybrookeduehs, and THIS PERMIT MUSTBE POSTED AT THE - fill out these blank fields.

Guidelines on how to fill out Form Ehsd0087C portion 3

Be really careful while completing Reviewed by and THIS PERMIT MUSTBE POSTED AT THE, because this is the part in which most people make a few mistakes.

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