Dd Form 2975 - Temporary Food Event Coordinator'S Application Page 3
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3TEMPORARY FOOD EVENT COORDINATOR'S APPLICATION
18. Describe garbage disposal during the event (type, number, location of containers; removal):
19. Number of attached continuation pages:
20. APPLICANT/COORDINATOR STATEMENT: I hereby certify that the above information is correct and I fully
understand that any deviation from the above without prior permission from the Medical Authority or designated
representative and the event sponsor may nullify final approval.
a. APPLICANT/COORDINATOR SIGNATURE
b. DATE
c. CO-APPLICANT/COORDINATOR SIGNATURE
d. DATE
21. REGULATORY AUTHORITY: Approval of these plans and specifications by this Regulatory Authority does not
indicate compliance with any other code, law or regulation that may be required (i.e., Federal, state, or local).
Furthermore, it does not constitute endorsement or acceptance of completed food establishments (structure or
equipment). A pre-opening inspection of all food operations with equipment in place and operational will be necessary to
determine compliance with the Tri-Service Food Code and local and state laws governing food service establishments.
Approved
Date
Disapproved
Date
:
Establishment Restrictions:
Reason(s) for Disapproval:
22. AUTHORIZED DATES TO OPERATE
23.a. REVIEWER (Print full name and rank)
b. TITLE
c. SIGNATURE
d. DATE
DD FORM 2975, NOV 2013
Page 3 of 3 Pages
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