APPLICATION FOR PERMIT TO OPERATE TEMPORARY FOOD ESTABLISHMENT PLEASE COMPLETE AND RETURN TO THE ENVIRONMENTAL HEALTH FIELD SERVICES (EHFS) OFFICE LOCATED IN THE COUNTY IN WHICH THE TEMPORARY FOOD ESTABLISHMENT WILL BE OPERATED. EHFS New Castle County EHFS Kent County EHFS Sussex County Limestone Prof. Ctr., Suite 100 - Williams State Serv. Ctr. Georgetown State Serv. Ctr. 2055 Limestone Road 805 River Road 544 South Bedford Street Wilmington, DE 19808 Dover, DE 19901 Georgetown, DE 19947 Phone: 302-995-8650 Phone: 302-739-5305 Phone: 302-856-5496 Fax: 302-995-8323 Fax: 302-739-7013 Fax: 302-856-5065 Name of Event: ____________________________________________ Date(s) of Event: ____________________________ Location of Event: _________________________________________________________________________________________ Business / Organization Name: ______________________________________________ Phone # : ____________________ Contact Person: _________________________________ Day Phone # : ______________ Fax # : ____________________ Applicant Mailing Address: _________________________________________________________________________________ City: ___________________________________________ State: __________ Zip Code: ___________ Name of Person-in-Charge of this Temporary Food Estab at Event: ____________________________________________ Proposed Menu: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Site of Food Preparation (if other than Event location): ___________________________________________________ Source of Foods (including milk, ice): _____________________________________________________________________ _________________________________________________ Source of Water: ________________________________________ Methods used for cooking food to required temperatures: ____________________________________________________ Methods used for maintaining cold food at 41° F or lower: __________________________________________________ Methods used for maintaining hot food at 140° F or above: __________________________________________________ Hand washing Facilities (Describe): ________________________________________________________________________ Utensil washing Facilities (Describe): _____________________________________________________________________ In applying for a Temporary Food Establishment permit, I understand that failure to comply with all food safety requirements may result in the suspension of the permit, at which time all food operations must cease, until corrective action is taken and approved. __________________________________________________________ ________________________________ Signature and Title of Applicant Date << FOR OFFICIAL USE ONLY >> Application Reviewed: _____ Applicant Interviewed: _____ Application Approved by: _____________________________ Date: ____________ Approved with Following Revisions: _______________________________________________________________________________________ Risk Rating: PHF______ + ER______ + OR ______ = _______ Doc.# 35-05-20/08/04/11