Type Full Name :
Sign With Hand
Name
Certification
Onsite Operator
Food Preparation
If "No", where will food be prepared?
Vendor Information
State
Email
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
www.allendalenj.gov
ZIP
Email
Temporary Food Event
Application
Event Start Date
Fees
Email
Where is food purchased? (Maintain receipts for inspection)
Contact Person Information
Phone #
City
Amount Due
Site Set Up
City
City
Address
{[PNAME]} are assessed at the fixed rate of $40.00 per license.
Menu items to be served:
State
Event End Date
Commissary Information
License Fee
Applicant Signature
If "Other", please specify
Phone #
State
ZIP
Phone #
Address

Copies of the following items must be submitted with your application prior to the event:

  1. Business License and Certificate of Insurance
  2. Food Safety Program Certification
  3. Last Inspection report
  4. Commissary License – if applicable
  5. Commissary Inspection report – if applicable
  6. Photos of truck equipment and sinks – if applicable for truck or trailer

All stages of food activities require Health Department oversight. Commissary kitchen paperwork in another business name will not be accepted.

Phone #
Time vendor will be set up for inspection?
Event Name
Name
I certify to the best of my knowledge that all information supplied is true and correct. I have received, read and understand “Requirements for Temporary Food Events.” I understand that event participation approval is based on Health Department application review and vendor pre-screening.
Email
Phone #
If food is prepared at a commissary, please fill out the following information:
Attachments
Event Information
Address
Email
Is a commissary used in food preparation?
Event Coordinator Name/Organization
Business Owner/Entity Name
ZIP