Temporary Food Establishment Application For Vendors Form - Denville Division Of Health, New Jersey Page 4

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Township of Denville Health Department 
Commissary Agreement for Temporary Food Vendors   
 
 
The use of an off‐site kitchen must be reviewed and approved by the Health Department (this 
does not include licensed retail food establishments).  A vendor requiring the use of an off‐site 
kitchen facility must complete the following information: 
 
          I,  _____________________________________  allow ____________________________ to use  
                   Kitchen Owner/Operator                                                       Organization 
 
Name of Establishment/Kitchen:   
 
______________________________________________________________________________ 
 
For:    
Food Preparation 
 
Cooling Food 
Cold Food Storage 
Cooking 
Hot Holding 
Dry Food Storage 
Warewashing 
 
Date kitchen will be used for this event:  ____________________________________________   
 
Time of use:  _____________________ 
 
Name of Kitchen Owner/Operator:  ________________________________________________ 
 
_________________________________________      ______________ 
_________________ 
          Signature of Kitchen Owner/Operator                              Date                              Phone 
 
Kitchen Facility Address:  _________________________________________________________ 
 
……………………………………………………………………………………………………………………………………………………. 
For Office Use Only 
 
Approved 
Denied 
Comments:  
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________ 
 
 
A copy of the most recent health department license or Satisfactory posting for the 
Establishment/Kitchen referenced above must be submitted with this form. 

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