Temporary Food Service Permit Application printable pdf download

Caroline County Health Department

Division of Environmental Health

______________________________________________________________________________________

Leland Spencer, M.D., MPH, Health Officer

Attillio Zarrella, Th.D., Deputy Health Officer

TEMPORARY FOOD SERVICE PERMIT APPLICATION

THIS APPLICATION MUST BE SUBMITTED A MINIMUM OF 3 WEEKS PRIOR TO EVENT.

These instructions apply to any person/organization which establishes a Temporary Food Service Facility to sell or provide food to the

public for a temporary period.

How to apply:

1. Carefully read the entire application (7 pages).

2. Complete the application. Return pgs 1 & 2 to this department. Retain pgs 3-7, these pages must be on site during the event.

3. Applicant must be available for an interview with the Food Program Supervisor before final approval can be granted.

FACILITY/ORGANIZATION NAME:

CONTACT NAME:

MAILING ADDRESS:

CITY/STATE/ZIP:

CONTACT PHONE:

ALTERNATE PHONE:

FAX:

EMAIL:

NAME OF EVENT:

DATE(S) OF EVENT:

LOCATION OF EVENT:

BAKE SALES & COTTAGE FOODS –

Per COMAR 10.15.03, no permit is required to sell baked goods & Cottage Food products that are non-potentially hazardous. Baked

goods are breads, cakes, cookies, and pastries that are cooked with dry heat. Fruit pies made from high acid fruits such as apples,

cherries, strawberries, etc. are acceptable. Potentially hazardous baked goods such as pumpkin/sweet potato pies, cheesecakes,

meringues, and pastries with potentially hazardous fillings or toppings are prohibited. Baked Goods & Cottage Foods must be labeled

according to COMAR 10.15.03.27 (compliance sheet attached).

Foods shall not be prepared in homes where there are house pets, reptiles, birds, etc. All foods shall be prepared, portioned, and

packaged in a sanitary environment prior to transporting to the sale location. Food preparers shall not have open wounds or sores on

hands or forearms and be in general good health.

I understand that failure to comply with COMAR 10.15.03 Regulations Governing Food Service Facilities will result

in the automatic suspension of the operating license, and all food operations must cease IMMEDIATELY.

Signature of Applicant:

Date:

-HEALTH DEPARTMENT USE ONLY-

 Approved

 Disapproved

Health Department Signature:

Date:

Date Received: ____________

ID: ____________

Set Up Time: ___________

Water Supply From: _________________

Revised-September 2015

403 S 7

Street, Rm 248, Denton, MD 21629

PHONE: 410/479-8045

FAX: 410/479-4082

Temporary Food Service Permit Application

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