Get Consent For Use Of Permitted Establishment As A Commissary ... - Adph

Filling out the Consent For Use Of Permitted Establishment As A Commissary form is a crucial step for mobile food unit owners who need to establish a base of operations. This guide will provide clear instructions on each section of the form to ensure a smooth completion process.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to obtain the Consent For Use Of Permitted Establishment As A Commissary form. This action will allow you to access the document in a convenient online format.
2. In the designated area, print your name clearly as the Commissary Owner. Ensure that the spelling is accurate to avoid any issues regarding the permit.
3. Next, indicate the name of the mobile unit owner in the appropriate field. This is essential for establishing the relationship between the commissary and the mobile unit.
4. Fill in the name of the permitted commissary in the corresponding section. This name must match what is registered with your local Health Department.
5. Provide the complete address of the commissary in the specified field. This should include the street address, city, state, and zip code.
6. Sign and date the form in the provided fields to validate the agreement. This signature confirms your understanding of the Health Rules and the responsibilities involved.
7. Lastly, the form must be verified by an environmentalist. Ensure the verification section is filled out, including the name and date, as this is crucial for compliance with local regulations.
8. Once all sections are complete, you may save, download, print, or share the form as necessary to submit it to the relevant health department.

Complete your documents online today to ensure your mobile food establishment operates smoothly.