Type Full Name :

Sign With Hand

State

Address

Submitting an application that is incomplete or submitted less than 10 business days prior to start of the event can result in Permit Denial. Permits will be issued after inspection.
Signed Commissary/Serving Area Documentation must be attached before submitting the Application

Method used to Wash Utensils

Site of Preparation

Zip

End Date

Permit Type

Method used to maintain Hot Food at 135° F or Above:

Event Coordinator Details

Name

Phone #

{[CNAME]}Division of Health
2100 Greenwood Avenue
Hamilton, NJ 08609
Office (609) 890-3828
Fax (609) 890-6093

Address

Name

General Instructions

Phone #

Applicant Details (Business/Organization)

Menu and Food Preparation

Method used to Wash Hands

Please provide the following documents (If Applicable):

Driver's License
Proof of Insurance
Vehicle Registration
Copy of NJDOH Cottage Food Operator
Signed Commissary/Serving Area Documentation
Comissary Related Documents:

Copy of latest Inspection Report
Copy of Retail Food License
Copy of Latest Evaluation Placard

Is the TFE a Mobile Vehicle?

Method used to maintain Cold Food at 41° F or Lower:

By signing this Mobile/Temporary Food Establishment (M/TFE) application, I understand that my M/TFE may be inspected at any time during the event, including during setup. Failure to comply with NJAC 8:24 and requirements for operating a M/TFE may result in suspension of my operating permit, at which time I must immediately cease all food establishment operations.

Issuing State

Zip

License Plate #

Application Fee

Application Type

Certification

{[PNAME]}
Application

State

City

Source of Water

State

Address

Name of Preparation Site

Phone #

Source of Food

Source of Ice

The Fee for this Application is:

Start Date

Name

Zip

Is the TFE operating from a Tent or MFU?

City

Required Documents

Primary Contact Person/Person in Charge

Event Details