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Gardner Food Truck Festival - Food Establishment Application - Temporary

2. Gardner Food Truck Festival - Registration for Food Establishment (Temporary)

4. Establishment/ Business Name:*

5. Phone Number:*

7. Address of Business*

9. City*

10. State*

11. Zip Code*

13. Name of person responsible for this temporary food operation*

    Who will be in charge of the operation at the event?

15. Do you or your establishment currently possess an annual food license from the Gardner Board of Health?*

    1. Yes
    2. No

16. If yes, which type of license?
    -- Select One --Food Service RetailMobile

    Select from drop down menu

18. Source of potable water:*

19. Location of Hand Washing Facilities:*

21. Location of toilet facilities:

22. Method and Type of Sanitizer Used:*

24. List all foods to be served, including brand names:*

26. How do you propose to keep potentially hazardous food above 140 degrees Fahrenheit?*

28. How do you propose to keep cold food below 45 degrees fahrenheit?*

30. By checking the box below, I agree that food thermometers will be used at the event*

    1. I Agree

34. Upload your ServSafe Certificate:*

35. Upload your most recent inspection certificate:*

36. Upload a copy of your Board of Health License from the town you operate in*

38. Upload your Allergen Awareness Certificate *

39. Upload a proof of your base of operation*

    Letterhead, commissary letter, contract, etc.

41. Upload a copy of your Business License*

43. Please read the State Sanitary Code Requirement Checklist below
    State Sanitary Code Requirements

45. Electronic Signature*

    I hereby certify, under the penalties of perjury, that the information I provided in the above section is correct to the best of my knowledge and understanding. I also certify that by typing my name into the above field, that I am electronically affixing my signature to the document.

    
    By signing this section, I agree that I will use food thermometers at the event. I agree to abide to the State Sanitary Code Requirement Checklist from the link above.

46. Date:*
    Date:

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field