The Application for Facility Evaluation Request Form (FY 2026-2027) is a food program form of the Sacramento County Environmental Management Department (EMD), Environmental Health Division. A proposed owner of a food facility uses it to request, or to decline, a facility evaluation before taking over ownership. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form itself is published by EMD at the official source link.
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What is Application for Facility Evaluation Request Form – Sacramento County, CA?
The Application for Facility Evaluation Request Form is the Sacramento County Environmental Management Department (EMD) form on which a proposed owner of a food facility states whether a facility evaluation is requested, and describes the menu, equipment and building changes planned for the facility.
EMD defines a facility evaluation as an inspection and consultation held at the facility you are planning to take over. Its purpose is to review the last inspection report, including any violation corrective time frames, and to find out whether changes or alterations have occurred since that inspection. Changes or alterations may require corrective action or the submittal of plans to plan review. During the evaluation the Environmental Specialist (ES) tells you what actions are necessary for the facility to comply.
The form is issued by the County of Sacramento Environmental Health Division and is labeled FY 2026-2027, Rev. 07/01/26. The reference to compliance is to the California Health and Safety Code (CalCode). A fee applies to the evaluation; the amount is printed on the form.
The form is listed on the EMD Food Program Forms and Documents page next to other food forms, such as the Application for Food Facility Plan Review (2026-2027). It is a separate document from those applications.
Who needs to file Application for Facility Evaluation Request Form – Sacramento County, CA?
Proposed owners who are planning to take over ownership of an existing food facility in Sacramento County use this form. They choose one of the statements printed on it:
- Not requesting an evaluation: the proposed owner is not requesting a facility evaluation and/or has already assumed ownership and is operating the facility. By signing, the owner accepts responsibility for completing any corrective actions on the last inspection report and for any changes or alterations made since that inspection, whether made by the owner or the previous owner.
- Requesting an evaluation: the proposed owner asks for the evaluation and agrees to pay the associated fee.
- Evaluation required: a third statement says the evaluation is required because the facility has been closed and no routine inspection has been conducted within the last 6 months, as determined by EMD staff.
The form asks for the signature of the proposed owner. It does not describe who else may sign on the owner's behalf.
When to file Application for Facility Evaluation Request Form – Sacramento County, CA
The form is tied to a change of ownership of a food facility: it asks for the Date of Proposed Change of Ownership, so it is completed when you are planning to take over a facility. EMD says an evaluation may be required if the facility has been closed and no routine inspection has been conducted within the last 6 months. EMD staff make that determination. The form prints no separate filing deadline or processing time; contact the Environmental Health Division at (916) 875-8440 to ask about timing for your takeover.
How to fill out Application for Facility Evaluation Request Form – Sacramento County, CA
Read the facility evaluation description
Review the printed explanation at the top: a facility evaluation is an inspection and consultation at the facility you plan to take over, and a fee applies. Leave the OFFICE USE ONLY box blank.
Enter the food facility name and address
Fill in the Food Facility Name and Food Facility Address fields with the facility you are planning to take over.
Describe the type of food
Question 1: write what type of food you intend to serve.
List your menu items
Question 2: list the food and beverage items on your menu.
Answer the equipment question
Question 3: check Yes or No to whether you have changed, or intend to change or remove, any equipment within the existing facility.
List equipment changes if applicable
Question 4: if you answered Yes to question 3, list the new, replaced or removed equipment.
Answer the structural changes question
Question 5: check Yes or No to whether you have changed or intend to make any structural, plumbing, mechanical or electrical changes. If Yes, explain the changes.
Choose the statement that applies
Check the statement declining an evaluation or already operating the facility, or the statement requesting an evaluation and agreeing to pay its fee. The third statement applies when EMD staff determine the evaluation is required.
Add contact and ownership change date
Enter your Contact Phone Number and the Date of Proposed Change of Ownership.
Sign, review and download the PDF
Sign and date on the Signature of Proposed Owner line. Check every answer, then download or print the completed PDF from FillingPDF and contact EMD as described under How to submit.
How to submit Application for Facility Evaluation Request Form – Sacramento County, CA
The form does not print a submission channel, deadline or instructions for returning it. Its header and footer identify the office that issues it:
- Office: County of Sacramento, Environmental Management Dept., Environmental Health Division, 11080 White Rock Road, Ste. 200, Rancho Cordova, CA 95670.
- Phone: Environmental Health (916) 875-8440; Environmental Protection (916) 875-8550.
- Fax: (916) 875-8513.
- Websites: www.saccounty.gov and www.emd.saccounty.gov.
Call the Environmental Health Division to confirm how it accepts the completed form and how to pay the evaluation fee. The fee amount is printed on the form. Leave the OFFICE USE ONLY box, the Received by line and the Assigned to Supervisor line blank. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Treating the evaluation as optional when EMD staff have determined it is required because the facility was closed with no routine inspection in the last 6 months.
- Signing the statement that you are not requesting an evaluation without understanding that you become responsible for corrective actions on the last inspection report and for all changes since that inspection.
- Answering Yes to question 3 about equipment and leaving question 4 (the list of new, replaced or removed equipment) blank.
- Answering Yes to question 5 about structural, plumbing, mechanical or electrical changes without explaining the changes.
- Making a change or alteration to the facility without plan review approval; the form warns this may lead to closure or other enforcement action.
- Operating with equipment that is insufficient for the scope of your operation and food preparation activities, which the form says may lead to closure until you comply with CalCode.
- Writing in the OFFICE USE ONLY box or the Received by and Assigned to Supervisor lines, which are reserved for EMD.
- Leaving the signature, the contact phone number or the Date of Proposed Change of Ownership empty.
Frequently asked questions
What is the Application for Facility Evaluation Request Form?
It is a Sacramento County Environmental Management Department form on which a proposed owner of a food facility requests, or declines, a facility evaluation. The evaluation is an inspection and consultation at the facility you plan to take over, held to review its last inspection report and any changes.
Is the Sacramento County business license the same as this form?
No. This form is a food program document from the Environmental Management Department's Environmental Health Division. It concerns a facility evaluation before a change of ownership of a food facility, and it is not presented by EMD as a business license.
When is a facility evaluation required?
EMD says an evaluation may be required if the facility has been closed and no routine inspection has been conducted within the last 6 months. EMD staff make that determination, and the form has a statement you sign when the evaluation is required for that reason.
Is there a fee for the facility evaluation?
Yes. The form says a fee applies to the evaluation and prints the amount for FY 2026-2027. By checking the request statement you agree to pay it. Call the Environmental Health Division at (916) 875-8440 to ask how to pay.
What happens if I do not request an evaluation?
By signing the statement declining an evaluation, you accept responsibility for any corrective actions on the last inspection report and any changes since that inspection, whoever made them. The form warns of possible closure or enforcement action for changes made without plan review approval.
Where do I send the completed facility evaluation form?
The form names no submission channel. It lists the Environmental Health Division at 11080 White Rock Road, Ste. 200, Rancho Cordova, CA 95670, phone (916) 875-8440 and fax (916) 875-8513. Call to confirm how it accepts the form.
Can I fill out the facility evaluation request form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not submit the form to EMD or take payment; you deliver it through EMD's channels.
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