Notification of Intent to Operate a Mobile Food Establishment or Special Transitory Food Unit

Mobile Food Establishment or Special Transitory Food Unit

Must be received four (4) days prior to event

Name of Unit

Name of Operator

Business Address

Cell Number

Health Department License Number

OK to Text?

Yes

Name of Event

Operation Start Date

Operation End Date

Hours of Operation

Location of Operation Site

Campus Building Name and/or Address

Name of the Local Health Department (LHD) where STFU or Mobile is licensed

If MDARD licensed, list the county where licensed

List all menu items that will be served at the event

If you are human, leave this field blank.