ABC County Health Department
Powered By SBS Portals
ABC County Health Department
Application for Temporary Food Vendor
Business Name
Owner Name
Mailing address
City
State
Zip
Business Telephone
Email Address
On-site Manager name
Name of Event
Dates
Start Time
Daily Hours of Operation
Location of the Event
Foods to be Served
Where is food stored prior to preparation?
Food stand
Other
Supply truck
How will you dispose of waste water
Holding tanks
Public utility
Potable water source
Bottled water
Private supply (well)
Public utility
Structure Type
Booth
Other(describe)
Permanent building
Self-contained trailer
Tent
Comments
This certification is required after January 1, 2005 for one employee.
FEES ARE LISTED BELOW
If the application is received:
7 or more days prior to the event--$20 per day. Maximum $80
6 or fewer days prior to the event--$30 per day. Maximum $120
Signature
Title
Date
(mm-dd-yyyy)
Amount
Attach Document (PDF, JPG, PNG, GIF, TIFF Only)
Enter the code here
