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EDISON Thomas Lankey Mayor DEPARTMENT OF HEALTH 100 Municipal Blvd. Edison NJ 08817 Jay P. Elliot Director jelliot edisonnj. org 732-248-7273 TEMPORARY RETAIL FOOD ESTABLISHMENT APPLICATION Location of Event Date of Event Time you will be on Site Name of Caterer Phone Address of Caterer You must submit a copy of your commissary s last inspection report along with this application. Contact Person on Site Cell Phone Proposed Menu Facilities to maintain cold foods specify Hand Wash Sanitizing Facilities Must Be Provided Frozen Foods 0F Re-Heated Foods 165 F Refrigerated Foods 41 F Hot Holding of Foods 140 F Disposable Plastic Gloves Required Stem Thermometer Required FEES One location for more than three 3 consecutive days 200. EDISON Thomas Lankey Mayor DEPARTMENT OF HEALTH 100 Municipal Blvd. Edison NJ 08817 Jay P. Elliot Director jelliot edisonnj. org 732-248-7273 TEMPORARY RETAIL FOOD ESTABLISHMENT APPLICATION Location of Event Date of Event Time you will be on Site Name of Caterer Phone Address of Caterer You must submit a copy of your commissary s last inspection report along with this application* Contact Person on Site Cell Phone Proposed Menu Facilities to maintain cold foods specify Hand Wash Sanitizing Facilities Must Be Provided Frozen Foods 0F Re-Heated Foods 165 F Refrigerated Foods 41 F Hot Holding of Foods 140 F Disposable Plastic Gloves Required Stem Thermometer Required FEES One location for more than three 3 consecutive days 200. 00 75. 00 No applications will be accepted any later than 48 hours prior to the event. Visa/Mastercard/Discover Name on Card Card Expiration Date CID Signature of Applicant License Number License Expires. org 732-248-7273 TEMPORARY RETAIL FOOD ESTABLISHMENT APPLICATION Location of Event Date of Event Time you will be on Site Name of Caterer Phone Address of Caterer You must submit a copy of your commissary s last inspection report along with this application* Contact Person on Site Cell Phone Proposed Menu Facilities to maintain cold foods specify Hand Wash Sanitizing Facilities Must Be Provided Frozen Foods 0F Re-Heated Foods 165 F Refrigerated Foods 41 F Hot Holding of Foods 140 F Disposable Plastic Gloves Required Stem Thermometer Required FEES One location for more than three 3 consecutive days 200. 00 75. 00 No applications will be accepted any later than 48 hours prior to the event. Visa/Mastercard/Discover Name on Card Card Expiration Date CID Signature of Applicant License Number License Expires.

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