State
List all menu items that you would like to serve at the event. Note if they are prepared or cooked on site, or in advance.
Phone #
Event Start Date and Time
{[PNAME]}
City
Name of Event
Event Information
Specify Address of the Event. (If Address is Unknown, Please Select "Non Resident or Address Not Found")
Event End Date and Time
ZIP
If your event is longer than one day, please list out all dates and times
Name of Event Coordinator
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
**Please submit this application to the Health Department at least two weeks prior to the event.
Location of the Event
Email
  • Contacts Information
  • Event Information
  • Attachments
  • Commissary Agreement
  • Certification
Owner Name
Business Owner Information
Vendor Information
State
Email
State
City
Business Owner Same as Vendor?
Emergency Contact
Expiration Date
Licensing Town
City
Certificate #
Commissary: All temporary and special event vendors are required to have a commissary where all food storage, food prep (including washing and cutting of produce), baking, and cooking shall be done..
Email
Name
If your operation does not require a commissary agreement, please provide the explanation.
City
Certified food manager name
Commissary Information
License #
Phone #
State
Owner Name
ZIP
Commissary Address
President/Manager (if applicable)
Phone #
Commissary Agreement Permission
Name
License #
Email
Establishment Name
Phone #
ZIP
Address
Phone Number
Certified food manager expiration date
Address
Business Name
ZIP
Is a Commissary (or Commercial Kitchen) Used in Food Preparation?
Temperatures Maintained During Transport
Other
Event
Food-grade disposable gloves
Other
Event
Where will wastewater be disposed?
Will you be using a hose to obtain water?
Deli tissue
How will foods be held hot at the event?
Other
Other
Commissary
Tongs
How will bare hand contact with ready-to-eat foods be prevented?
Food Handling and Temperature Control
Water and Ice
If yes, is the hose food-grade quality?
How will foods be held cold at the event?
Insulated cooler, bag, plastic container
Commissary
Mechanical Refrigerators/Freezer
Other
Handwashing Station
How will food temperatures be maintained during transport?
Commissary
Other
Do you have a backflow preventer for the hose?
Other
Where will you obtain potable water?
If you have ice for human consumption, where will ice be obtained?
What sanitizer will be used?
Other
Other
Where will utensil/dish washing take place?
Other
A handwashing station capable of providing a continuous flow of warm, running water is required within each booth or unit, unless only prepackaged foods are being sold. Please select one of the following:
Sanitizing

Handwashing Set-Up

1. A container with a hands-free spigot that is capable of holding a minimum of 5 gallons of water.
2. 5 gallons of potable water (minimum) that will be replenished, as necessary.
3. Pump Soap.
4. Paper towels.
5. A container to catch the wastewater until it can be disposed of properly.
6. A trash can for disposing of paper towels.

Gloves and hand sanitizers DO NOT take the place of washing hands with soap and running water.

Event
Attachments
  • Please include with your application a drawing of the booth layout that includes all cooking and cold/hot holding equipment, hand washing as well as a menu. Incomplete applications will delay the approval process.
  • Applicant is responsible for obtaining all other required city, county, and/or state approvals/inspections prior to the event.
  • Provide copy of current and valid Satisfactory Placard and license for that commissary (if applicable).
Type Full Name :
Sign With Hand
(PWSID#)
Servicing and cleaning of equipment and utensils
Commisary Signature
of
A Commissary Use Log will be maintained and made available to the department upon request. Indicate how and where the Commissary Use Log will be maintained:
Commissary Agreement
I,
Warewashing
Storage of foods, single-service items, and chemicals
(This Commissary Agreement is Only Valid for the Current Year)
Preparation of food, such as washing produce, peeling or cutting foods, cooking, cooling, reheating
Other
Commisary Signature Date
Give my permission to
Located at
Commissary Water Supply
of
Dumping waste water
Commissary Sewer Service
Filling water tanks (must have food grade hoses)
Type Full Name :
Sign With Hand
Certification
Temporary retail food establishment license fee is $30.00. This fee is waived if the applicant operates a licensed retail food establishment within Linden.
License Fee
Applicant Signature
Fee
The undersigned do hereby apply for a license to operate a food business in the {[CNAME]}. I/We agree to abide by the regulations and ordinances of the Township and the State of New Jersey.