Environmental Division Applications, Forms & Documents

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Environmental Health DivisionPlanning, Building & Environmental Services

Farmers Market

Retail Plan Check Guide for Food Facilities Pool-Fecal, Vomit, Blood and Drowning Incident Protocol Pool-Fecal, Vomit, Blood and Drowning Incident Protocol

Applications, Additional Forms & Information

Finding What You Want:

The Environmental Health Division has a number of applications, submittal forms and informational documents to help you with your Environmental Health and Land Use needs. If you can't find what your looking for using the links below, or not sure exactly what you need, Environmental Health Division staff is available to help. Staff is available for consultation and application services weekdays (excluding holidays) from 7:30 am to 4:15 pm. If you have questions about applications, permitting, health codes, violations, or general food and establishment safety use the informational links provided, or feel free to contact us for assistance.

Available Documents:

 

 

Consumer Protection

 
  

Land Use

 
  

 Pollution Prevention 

 
  

Solid Waste 

 

 APPLICATIONS

 APPLICATIONS

 APPLICATIONS

  APPLICATIONS

  Applications for Consumer Protection

  Applications for Land Use

  Applications for Pollution Prevention

  Applications for Solid Waste

Temporary Event Vendor Application

Application for Wastewater Hauling Permit

Business Activity Page

 

Temporary Event Organizer Application

ASTS Plan Submittal Checklist 2012

 

 

Cottage Food Operation Permit Class B

Conventional Sewage Disposal Application Form

 

 

Cottage Food Operation Registration Class A

City of St. Helena Well Permit Application

 

 

Current Record Update Form 06-13

Geothermal Heat Exchange Well Application

 

 

Farmers Market Organizer Application

Groundwater Application 2012

 

 

Water System Permit Amendment Application

Instructions for Completing Groundwater Permit Application

 

 

Water System Permit Application 

Instructions-Supplemental App. and RUF

 

 

Plan Check Application for Food Facilities

Ministerial Groundwater Application 2012 

 

 

Pool Plan Check Application Worksheet 2013

Monitoring Well Permit Application 

 

 

 

Pumper Truck Application Form

 

 

 

Record Update Form (RUF)-Onsite Wastewater

 

 

 

Service Provider Application 

 

 

 

Soil Boring Permit Application

 

 

 

Supplemental Application for ASTS

 

 

HANDOUTS

Supplemental Application for NEW OWNERS 

 

 

Pamphlets to help you avoid common pitfalls 

Water Well Construction Application

 

 

Best Stormwater Management Practices for Food Facilities  

Water Well Destruction Application

 

 

Best Stormwater Management Practices for Food Facilities  

 

 

 

Best Stormwater Management Practices for Food Facilities  

  HANDOUTS

  HANDOUTS

  HANDOUTS

B & B Pool Sign

  Pamphlets to help you avoid common pitfalls

  Pamphlets to help you avoid common pitfalls 

  Pamphlets to help you avoid common pitfalls 

Caterers

ASTS Landscaping Guidelines 

Welcome Packet

Agreement, Solid Waste, Recyclable Materials, Green Waste Collection

Food Demonstration and Sampling Requirements

ASTS Service Providers List 2013

 

Clinic Ole Expired Medication

Food Facility Person in Charge

 ASTS Standards-Final Draft Document-November   

 

Sharps Disposal Guide

Food-Notice of Availability of Inspection Report

Backwash Guidelines May 2011 

 

 

Food-One Day Non Profit Temp Event Checklist

Building Permit Requirements-Well -Septic

 

 

Food Safety Certification Providers 2012

Groundwater Permit Handout

 

 

Food-Trans Fat Ban CCDEH

Hold and Haul for Winery Wastewater Guidelines

 

 

Menu Labeling Guidelines from CCDEH

Napa County Approved List of Leach Field Chambers

 

 

MHP Inspection Guidelines for Residents

Percolation Test Guidelines 

 

 

Mobile Food Facility Information Regarding Other Napa County Agencies

Septic Tank Destruction Guidelines

 

 

Outdoor Beverage Bar Guidelines

Sewage Permit Issuance Requirements Updated 2012   

 

 

Pools-Cyanuric Acid

Sewage System Contractors

 

 

Pool-Fecal, Vomit, Blood and Drowning Incident Protocol

Site Evaluation Guidelines

 

 

Pool-Fecal, Vomit, Blood and Drowning Incident Record

Site Evaluation Professional List April 2017

 

 

Retail Plan Check Guide for Food Facilities

Spring Water Supply Requirements

 

 

Service Animals in Food Facilities 2010

Steps to construct and final and ASTS

 

 

Swimming Pool Maintenance

Wastewater Pond MOU 

 

 

Swimming Pool Maintenance

Wastewater Pumper Trucks 

 

 

Water Contaminant Arsenic Fact Sheet

Well Destruction Guidelines-2013 

 

 

Water Contaminant Coliform Fact Sheet

Well Owner Guide-State Water Board 

 

 

Water Contaminant Nitrate Fact Sheet 

Well Reconstruction Guidelines

 

 

Water-Interpreting Drinking Water Test Results

Well Septic ElectricalFloodplain Memo

 

 

Water Systems-Permit Instructions

Winery Pond FAQ

 

 

Water-Spring Guidelines

Winery Pond Fencing and Sign Requirements 

 

 

Water Testing Laboratories 

Winery Pond Online Reporting

 

 

Water Well Chlorination Instructions

Winery Pond Reporting Requirements  

 

Water Well Testing FAQ from CDC 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  SUPPLEMENTAL FORMS

  SUPPLEMENTAL FORMS

  SUPPLEMENTAL FORMS

  SUPPLEMENTAL FORMS

  Supplemental forms depending upon Application

  Supplemental forms depending upon Application

  Supplemental forms depending upon Application

  Supplemental forms depending upon Application

Authorized Agent Form

Agreement for Grant of Easement and Water Rights

 Emergency Response Plan 020813

 

Commissary - Restroom Verification Form for Mobile Food Facilities

Agreement for Grant of Sewage Easement

 

 

Cottage Food Operation Planning Department Authorization Form 

ASTS Septic System Self Monitoring Report

 

 

Fish Truck Compliance Agreement

At-Grade System Inspection Form

 

 

Food Plan Check Hood Performance Test

Burned Dwelling Replacement Guidelines

 

 

Handwash Sign

Contractor Inspection Report Form

 

 

Hotdog and Coffee Carts Compliance Agreement 

Conventional System Inspection Report Form

 

 

Ice Cream Truck Compliance Agreement 

Deed Restriction Well Destruction in Septic Reserve Area

 

 

MFF Pre-Packaged Food Vehicle

Electrical Certification Form

 

 

Mobile Food Facility Compliance Agreement

ElectricalPermit Water Well Septic Tank – No Associated Structure

 

 

Pools-Anti-Entrapment Devices Compliance Form

Electrical Permit Water Well  Septic Tank – With Structure

 

 

Produce Truck Compliance Agreement

Evaportanspiration Infiltration Bed Inspection Form

 

 

Swimming Pool Operating Records

Future Dwelling Agreement 

 

 

TFF Temp Event Food Booth Self Inspection Checklist

Future Winery Agreement

 

 

TFF Fee Waiver Request Form

Grease Trap Agreement

 

 

Water Agreement for Grant of Water Rights

Instructions for Water Agreement

 

 

Water Bacteriological Siting Plan 2013

Mound System Inspection Report

 

 

Water-Instructions for Agreement for Grant of Water Rights

Pressure Distribution Inspection Report

 

 

Water System Disinfection Byproduct Plan

Site Evaluation Report Form

 

 

Water System Emergency Notification Plan

Subsurface Drip System Inspection Report

 

 

 

Surface Drip System Inspection Report

 

 

  Watertight Certification Form