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									How to apply for a Temporary Food License:
1. Download and print the Temporary Food Service License Application 2. Download and print the Temporary Food Service Guidelines 3. Fill out all applicable information on the Temporary Food License Application. The following information must be included on page 1: A. Days operating B. Name of the Event C. Location of the Event (Address) D. Name of the Establishment/Organization (group name or the name of the booth). E. Address (original location of the organization or home address of the mobile unit). F. Contact person, including phone number. G. All applicable hours of operations H. Fee schedule. *Not for profit organizations must produce a proper not-for-profit statement (this is not your tax ID form). Contact the Secretary of State to secure this form. 4. Any and all applicable information on page 2 must be filled out. 5. A full list of all foods to be served must be included on page 3. Potentially hazardous foods must be listed in the corresponding chart, and all boxes applying to each potentially hazardous food must be checked. 6. Submit the application form with the corresponding fee a minimum of seven (7) working days prior to the event. Failure to do so could result in the closure of the food stand due to non-compliance or safety issues.

KANKAKEE COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH 2390 W. Station Kankakee, IL 60901 (815) 937-7860
AMT. RECD.__________________ CASH_________CHECK________ RECD BY_____________________ DATE RECD__________________ APPROVED BY________________

TEMPORARY FOOD SERVICE ESTABLISHMENT LICENSE APPLICATION I/We hereby apply for a license to operate a Food Service Establishment on a temporary basis in Kankakee County for a period of __________days, beginning on __________________ and
Date

ending on___________________________.
Date

Name of Event_________________________________________________________________ Location of Event_______________________________________________________________ Name of Establishment/Organization________________________________________________ Address_______________________________________________________________________ Contact Person_______________________________________PHONE ___________________ HOURS OF OPERATION Sun. __________to___________ Thurs. __________to__________ Fri. Sat. __________to__________ __________to__________

Mon. __________to___________ Tues. __________to___________ Wed. __________to___________

FEE SCHEDULE Temporary Food Sales 1 Day……………..( ) $25.00 2 to 14 consecutive days..........................( ) $40.00 ) No Fee

Not for Profit (must meet guidelines)................................................................(
Please return this signed, dated application and stipulated fee in the form of a money order ( ), check ( ), or cashier’s check ( ) made payable to

KANKAKEE COUNTY HEALTH DEPARTMENT THIS FORM AND FEE MUST BE SUBMITTED 7 WORKING DAYS BEFORE THE EVENT Mail Application and fee to: KANKAKEE COUNTY HEALTH DEPARTMENT Division of Environmental Health 2390 W. Station Kankakee, IL 60901

1. Indicate the origin of the food/beverages (i.e. where will the food be purchased or provided

from; include labels if possible) : ____________________________________ _______________________________________________________________________ 2. All food and beverage must be prepared on-site or in a licensed kitchen (not a domestic one).
Provide the following information for the facility where advanced food prep will take place

a. Facility name: ______________________________________________________ b. Address: __________________________________________________________ c. Date and time of advance preparation: __________________________________ 3. Indicate the distance and time for transporting food or beverage to the food service site. a. Distance: ______________ b. Time: __________________________

4. How will food temperatures be maintained during transportation (hot foods hot; cold foods cold)? _______________________________________________________________________ 5. Describe the equipment to be used at the event for: a. Cold holding_______________________________________________________ b. Hot holding________________________________________________________ c. Cooking___________________________________________________________ 6. Water Source: [ ] On-site municipal supply [ ] On-site well

[ ] Other________________________________________ 7. How will the waste water be disposed? ________________________________________ 8. Means for handwashing: [ ] Plumbed sink [ ] Gravity flow

[ ] Other ________________________________________ 9. Means of garbage disposal: [ ] Cans collected on-site [ ] Dumpster

[ ] Other ________________________________________

10. Statement from Applicant: I certify the information in this application is complete and accurate. I understand the Kankakee County Health Department does not provide verbal approval of the plans or the deviation of approved plans, and that any deviation from the plans and procedures in this application without prior written information from the Kankakee County Health Department may nullify final approval and result in my not obtaining a permit, or having the permit suspended or revoked after it is issued.

Signature: ______________________________________ Date: ________________

TEMPORARY FOOD SERVICE ESTABLISHMENT APPLICATION – Food Being Served and Methods of Preparation
POTENTIALLY HAZARDOUS FOOD ITEMS
(i.e. meat, fish, shellfish, poultry, eggs, milk and dairy products)

ADVANCE PREPARATION?
Yes/No

COOKING PROCEDURES PLEASE CHECK ALL THAT APPLY
THAW PREP COOK HOLD COOL OTHER

(List potentially hazardous foods to be served)

Explain the thawing method/process to be used at the event:_____________________________________________________________________

List remaining food and beverages to be served.

THIS SECTION IS FOR USE BY THE KAN

Approval of these plans and specifications by the Kankakee County Health Department does not indicate compliance with any other code, law or regulation th

PLAN APPROVAL BY: _______________________________________

DATE: _________________________ Vendor No.: ______________________

KCHD Comments:

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________ Sanitarian: __________________________


								
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