APPLICATION FOR A TEMPORARY FOOD SERVICE ESTABLISHMENT Event Name*Event Date(s)Event Date(s)Operating Time(s)Closing Time(s)Event LocationEvent Coordinator/OrganizerPhoneEmail address*Permit Applicant (Person/Organization)Booth NamePerson in ChargeMailing Street AddressPostal CodePhoneEmail address*Certified Food HandlerYesNoADDRESS WHERE THE FOOD WILL BE MADEDOES THE KITCHEN HAVE AHEALTH PERMIT? YesNoBooth menu attachedRoofOverhead protectionTentUmbrellaIndoorFloorCementRaised plywoodIndoor flooringHandwash stationPiped SinkPortableContainerLiquid Hand Soap Paper TowelsGarbage ContainerWaste waterSewerWaste ReceptacleFood contact sanitizer (Quat or chlorine)Sanitizer test stripsCooking equipment typeBBQ/grillHot plateDeep FryerOtherOtherHot Holding equipment typeElectricalInsulated containers (>60C/140F)OtherOtherRefrigerationMechanical (<5C/41F)Insulated coolers with ice packsTransport Hot >60C/140FTransport Cold <5C/41FRefrigerator/Cooler Thermometer(s)Metal Stem Probe ThermometerHair restraint(s)Apron(s)/Uniform(s)Single service utensilsFoods stored covered and protectedCommentsSendThis field should be left blank
