OSDH Form 824C "Plan Review Application for Manufacturing/Warehousing" - Oklahoma

This version of the form is not currently in use and is provided for reference only.
Download this version of OSDH Form 824C for the current year.

What Is OSDH Form 824C?

This is a legal form that was released by the Oklahoma State Department of Health - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Oklahoma State Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of OSDH Form 824C by clicking the link below or browse more documents and templates provided by the Oklahoma State Department of Health.

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Download OSDH Form 824C "Plan Review Application for Manufacturing/Warehousing" - Oklahoma

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Page background image
S
ubmit form w
with $425.00 n
nonrefundabl
le fee to:
Attn:
Consumer
Health / OK
K State Dep
pt of Health
h
PO Box 268
8815 / OKC
C OK 73126
6-8815
Of
ffice: (405) 2
271-5243 | F
Fax: (405) 2
271-5286
E
Email:
Con
nsumerHealt
th@health.o
ok.gov
Website
e:
http://chs
.health.ok.g
gov
PLAN R
REVIEW A
APPLICA
ATION FO
OR MANU
UFACTUR
RING/WA
AREHOUS
SING
Prog
gram Type:
Food
Drug
Non-Profi
fit/Charitable
e (Y/N):
Yes
No
Estab
blishment T
ype:
Manufactur
ring
Wholesaler
r
S
Salvage
Water Bo
ottling
(chec
ck all that ap
pply)
Water Vend
ding
Supplemen
nts
O
Other:
Type
e of Constru
uction:
New Constr
ruction/Faci
lity
Remodel of
f existing est
tablishment
Existing est
tablishment
changing the
e type of ope
eration
Conversion
n of existing
structure
Change of o
ownership w
with no chang
ges in operat
ation
Nam
me of Establi
shment:
Co
ounty:
Phys
sical Street A
Address:
City
:
State:
Zip C
Code:
OW
WNER / APP
PLICANT IN
NFORMAT
TION:
Appl
licant’s Nam
me / Title:
Prim
mary Phone #
#:
Se
econdary Ph
hone #:
Stree
et Address:
City
:
State:
Zip C
ode:
E-M
Mail Address:
:
Type
e of Ownersh
hip:
Individual
Par
rtnership
Corp
poration
LLC
(if ap
pplicable) St
tate Tax ID #
#:
and
d/or Federal
ID #:
CON
NTACT INF
FORMATIO
ON IF DIFF
FERENT F
ROM OWN
NER / APPL
LICANT:
Cont
tact’s Name
/ Title:
Prim
mary Phone #
#:
Sec
condary Pho
one #:
Stree
et Address:
City
:
State:
Zip C
ode:
E-M
Mail Address:
:
HEALTH DEP
PARTMENT USE
E ONLY
All
facilities mus
st be inspecte
ed and license
ed prior to ope
eration.
SUBMITT
TING THIS F
FORM DOE
ES NOT GIVE
E
Date C
Copy of Rules Rece
eived:
P
PERMISSIO
ONS TO OPE
EN AN ESTA
ABLISHMEN
NT.
OA
AC 310:225
Owner
OA
AC 310:240
OA
AC 310:257
Manager
Applic
cant’s Title
OA
AC 310:260
OA
AC 310:285
OSDH
H License #:
Applic
cant’s Signatu
ure / Date of
Signature
OSDH
H Receipt # / Date:
Oklaho
oma State Departm
ment of Health
ODH Form 824C
C
Consum
mer Health Servic
e
Page 1 of 3
(1/18
8)
S
ubmit form w
with $425.00 n
nonrefundabl
le fee to:
Attn:
Consumer
Health / OK
K State Dep
pt of Health
h
PO Box 268
8815 / OKC
C OK 73126
6-8815
Of
ffice: (405) 2
271-5243 | F
Fax: (405) 2
271-5286
E
Email:
Con
nsumerHealt
th@health.o
ok.gov
Website
e:
http://chs
.health.ok.g
gov
PLAN R
REVIEW A
APPLICA
ATION FO
OR MANU
UFACTUR
RING/WA
AREHOUS
SING
Prog
gram Type:
Food
Drug
Non-Profi
fit/Charitable
e (Y/N):
Yes
No
Estab
blishment T
ype:
Manufactur
ring
Wholesaler
r
S
Salvage
Water Bo
ottling
(chec
ck all that ap
pply)
Water Vend
ding
Supplemen
nts
O
Other:
Type
e of Constru
uction:
New Constr
ruction/Faci
lity
Remodel of
f existing est
tablishment
Existing est
tablishment
changing the
e type of ope
eration
Conversion
n of existing
structure
Change of o
ownership w
with no chang
ges in operat
ation
Nam
me of Establi
shment:
Co
ounty:
Phys
sical Street A
Address:
City
:
State:
Zip C
Code:
OW
WNER / APP
PLICANT IN
NFORMAT
TION:
Appl
licant’s Nam
me / Title:
Prim
mary Phone #
#:
Se
econdary Ph
hone #:
Stree
et Address:
City
:
State:
Zip C
ode:
E-M
Mail Address:
:
Type
e of Ownersh
hip:
Individual
Par
rtnership
Corp
poration
LLC
(if ap
pplicable) St
tate Tax ID #
#:
and
d/or Federal
ID #:
CON
NTACT INF
FORMATIO
ON IF DIFF
FERENT F
ROM OWN
NER / APPL
LICANT:
Cont
tact’s Name
/ Title:
Prim
mary Phone #
#:
Sec
condary Pho
one #:
Stree
et Address:
City
:
State:
Zip C
ode:
E-M
Mail Address:
:
HEALTH DEP
PARTMENT USE
E ONLY
All
facilities mus
st be inspecte
ed and license
ed prior to ope
eration.
SUBMITT
TING THIS F
FORM DOE
ES NOT GIVE
E
Date C
Copy of Rules Rece
eived:
P
PERMISSIO
ONS TO OPE
EN AN ESTA
ABLISHMEN
NT.
OA
AC 310:225
Owner
OA
AC 310:240
OA
AC 310:257
Manager
Applic
cant’s Title
OA
AC 310:260
OA
AC 310:285
OSDH
H License #:
Applic
cant’s Signatu
ure / Date of
Signature
OSDH
H Receipt # / Date:
Oklaho
oma State Departm
ment of Health
ODH Form 824C
C
Consum
mer Health Servic
e
Page 1 of 3
(1/18
8)
PLAN REVIEW APPLICATION GUIDELINES
Please submit the requested documentation that applies to your food or drug operation. If it does not apply, indicate Not
Applicable, “N/A” next to the documentation. Please be advised, due to the variation of manufacturing/
storage/salvaging operations, additional documentation may be requested specific to your operation.
SECTION I) GENERAL ESTABLISHMENT INFORMATION
a) Name of Establishment:
b) Physical Street Address:
c) Daily Operating Hours
Sunday:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Seasonal (Months):
d) Est. Number of Staff (maximum per shift):
e) Area (indicate # of total square feet)
Facility:
Kitchen Area:
f) Project Dates: Start of Project:
Completion of Project:
SECTION II) ADDITIONAL DOCUMENTATION CHECKLIST
List of proposed food/drug items to be processed or stored at the facility including:
☐ Product inventory
☐ Production schedule
☐ Recipe cards (manufacturing only)
☐ Labels which include (manufacturing only):
☐ Common or usual name
☐ Statements of ingredients
☐ Name & address of manufacturer or distributor
☐ Weight in English & metric units
Written plans including when applicable:
☐ Hazard Analysis Critical Control Point (HACCP) plan (manufacturing only)
☐ Process Authority Letters
☐ Standard Operating Procedures (personal hygiene, bare hand contact, vehicle sanitation, pest control, etc)
A minimum of one set of building plans including (where applicable & drawn to scale or show dimensions):
☐Architectural
☐ Plumbing (including labelled floor drains, floor sinks, etc.)
☐ Mechanical
☐ Electrical and Lighting
☐ Well (if applicable)
☐ Septic system
☐ Entrances, exits, loading/unloading areas and delivery docks
☐ Dumpster / garbage areas
☐ Storage areas
☐ Employee locker area
☐ Equipment Location (inside and outside)
☐ Sinks (labelled handwashing / warewashing / food prep. / mop / etc.)
☐ Toilet areas
(Multiple layouts/plans may be submitted as needed.)
Oklahoma State Department of Health
ODH Form 824C
Consumer Health Service
Page 2 of 3
(1/18)
Equipment - Manufacturer specification sheets for each piece of equipment used.
(Include custom fabricated equipment.)
☐ If no spec sheets available, photographs may be provided and/or detail drawings
Ownership Documentation (submit applicable documents):
☐ Completed Affidavit of Lawful Presence
☐ Copy of valid ID of individual owner (prior to licensure)
☐ Copy of Certificate of Incorporation if owned by LLC, INC, etc. (prior to licensure)
☐ Copy of Oklahoma Sales Tax ID (prior to licensure)
SECTION III) INSPECTION CHECK-LIST
Upon review of a complete application, the inspector will schedule an inspection. While this list is not all
inclusive, below are items that will be focused on during the inspection. To ensure a successful inspection and
issuance of license application, please ensure everything conforms with Oklahoma Administrative Code
(OAC) 310:260, Good Manufacturing Practice rules. A copy of the rules may be obtained on our Food –
Manufacturing webpage at
https://chs.health.ok.gov
or by calling 405-271-5243.
WASTE, WASTEWATER & WATER
Adequate means for disposal of refuse to minimize odor and harborage
OAC 310:260-3-4(f)
Wastewater disposed to approved sewage disposal/septic system
OAC 310:260-3-4(c)
(have a copy of DEQ approval for septic system)
Water sufficient & from approved source (have a copy of water bill/lab test available) OAC 310:260-3-4(a)
Water supply protected from backflow (air gaps / vacuum breakers)
OAC 310:260-3-4(b)(5)
EXTERIOR
Exterior doors, windows, delivery dock doors tight fighting
OAC 310:260-9-8
Roads and parking area well drained / dust free
OAC 310:260-3-2(a)
Grounds around the facility free of litter, waste, tall grass/weeds
OAC 310:260-3-2(a)
(including areas around external equipment)
PHYSICAL STRUCTURE
Building/structures suitable in size, construction & design for sanitary operations
OAC 310:260-3-4(g)
Floors/walls/ceilings smooth, washable, easily cleanable & impervious to water
OAC 310:260 -3-2(b)(4)
(including floor-wall junctures)
If used, floor drains sloped properly to allow for proper drainage
OAC 310:260-3-4(b)(4)
Lighting adequate in all food areas and restrooms
OAC 310:260-3-2(b)(5) & (6)
Hand wash sinks adequate/convenient w/hot & cold running water
OAC 310:260-3-4(e)
Restroom doors self-closing
OAC 310:260-9-6(a)
Restroom(s) & other areas emitting odors/vapors properly ventilated
OAC 310:260-3-2(b)(7) / 3-4(d)
Ensuring clothing/personal belongings stored in separate areas of food/operations
OAC 310:260-3-1(b)(7)
All shelving units and/or storage elevated at least 6” and away from wall
OAC 310:260-9-4(h)
MISCELLANEOUS
All freezers/cold storage compartments have accurate temperature device
OAC 310:260-3-5(e)
Transport vehicles maintained sanitary with adequate refrigeration (if needed)
OAC 310:260-7-1 & 9-10
PECAN PROCESSORS/CRACKERS have approved, sanitizing method
OAC 310:260-5-1
Personnel responsible properly trained (proof of training)
OAC 310:260-3-1(c) & (d)
Cleaning/sanitizing substances approved & properly stored
OAC 310:260-3-3(b) & (c)
Oklahoma State Department of Health
ODH Form 824C
Consumer Health Service
Page 3 of 3
(1/18)
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