-VINELAND HEALTH DERTMENT CITY OF VINELAND 640 EAST WOOD ST VINELAND, NJ 08360 HEALTHDEPARTME NT@VI NELANDCITY.ORG Submittal Date: _____ MOBILE RETL FOOD ESTABLISHMENT APPLICATION □ SEASONAL □ ANNUAL □ TEMPORARY PART 1 TO BE COMPLETED BY FOOD VENDOR MOBILE VENDOR BUSINESS INFORMATION Trading Name of Mobile Vendor:_________________________ _ Owner/Corporation:______________________________ _ Street Address:--------------------------------- City: ____________________ State: _______ Z ip: _____ _ Maing Address: (if different) __________________________ _ Home Phone#:_________ Cell#: _________ Fa : __________ _ Email: ------------------------------------ Contact Person: ___________ Phone#: ________ Cel l#: _______ _ Email: ------------------------------------ TYPE OF MOBILE UNIT CHECK ALL THAT APPLY □ Push Cart □ Tabletop/Tent □ Food Preparation Vehicle □ Trailer □ Reigerated Vehicle □ Other: Sanitation/Personal Hy�iene Other Equipment □Hot/cold Running Water □Trash Container □Freshwater Container gals □Sneeze Guards OWastewater Container gals □ Extra Utensils □Hand Sink w Warm Running Water □Covered Containers □Insulated Container w Free Flow Spout □Foil, Plastic Wrap 03 Compartment Sink w hot/cold running water □Thermometers □Buckets/Spray Bottles w/Sanitizer □Sanitizer/test kit □Gloves □ Paper Towels □Soap D MOBILE FOOD UNIT OPERATION SCHEDULE (CHECK/LIST ALL THAT APPL Where will you serve food:____________________________ _ Months: □ Events Only (see below) □ Every Month of Yr □ Selected Months (circle): J-F-M-A-M-J-J-A-S-O-N-D Days: □ Monday □ Tuesday □ Wednesday □ Thursday □ Friday □ Saturday □ Sunday Times of Operation:M ___ _ Tu__ _ W _ _ _ Th___F ___Sa ____ Su _ _ _ If Temporary/Special Event(s): Name of Event(s):-------------------------------- Days & Times at the Event:___________________________ _ Event Contact Person:_____________________________ _ Email: Phone#: -------------------- -------------- 1
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-VINELANDHEALTH DEPARTMENT
CITY OF VINELAND 640 EAST WOOD ST
VINELAND, NJ 08360 HEALTHDEPARTME NT@VI NELANDCITY.ORG
Submittal Date: _____
MOBILE RETAIL FOOD ESTABLISHMENT APPLICATION □ SEASONAL □ ANNUAL □ TEMPORARY
PART 1 TO BE COMPLETED BY FOOD VENDOR
MOBILE VENDOR BUSINESS INFORMATION
Trading Name of Mobile Vendor: _________________________ _ Owner/Corporation: ______________________________ _ Street Address:---------------------------------City: ____________________ State: _______ Zip: _____ _ Mailing Address: (if different) __________________________ _ Home Phone#: _________ Cell#: _________ Fax#: __________ _ Email:
------------------------------------
Contact Person: ___________ Phone#: ________ Cell#: _______ _ Email:------------------------------------
TYPE OF MOBILE UNIT CHECK ALL THAT APPLY
□ Push Cart □ Tabletop/Tent □ Food Preparation Vehicle □ Trailer □ Refrigerated Vehicle □ Other:
Sanitation/Personal Hy�iene Other Equipment □Hot/cold Running Water □Trash Container□Freshwater Container gals □Sneeze GuardsOW astewater Container gals □Extra Utensils□Hand Sink w Warm Running Water □Covered Containers□Insulated Container w Free Flow Spout □Foil, Plastic Wrap03 Compartment Sink w hot/cold running water □Thermometers□Buckets/Spray Bottles w/Sanitizer □Sanitizer/test kit□Gloves □Paper Towels □Soap D
MOBILE FOOD UNIT OPERATION SCHEDULE (CHECK/LIST ALL THAT APPLY)
Where will you serve food: ____________________________ _
Months: □ Events Only (see below)□ Every Month of Yr □ Selected Months (circle): J-F-M-A-M-J-J-A-S-O-N-D
Days: □Monday □Tuesday □Wednesday □Thursday □Friday □Saturday □Sunday
Times of Operation: M ___ _ Tu __ __ W _ _ _ Th ___ F ___ Sa ____ Su _ __ _
If Temporary/Special Event(s):
Name of Event(s): --------------------------------
Days & Times at the Event: ___________________________ _ Event Contact Person: _____________________________ _ Email: Phone#:
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