*Alabama Department of Public Health Application For ...
*Alabama Department of Public Health Application
For Exemption For Food Service at a Temporary Event
Name of Event: Event Location:
Event Type: Event Sponsored by:
Contact Person: Mailing Address:
Exempt
Type Facility
City:
Contact Phone: State: AL Zip:
Food To Be Sold
EARLIEST initial food preparations will begin:
LATEST final clean-up and removal from site:
Date:
Time:
Date:
Time:
EXEMPTION
NOTE: An exemption CAN NOT be issued to sell or otherwise use low acid foods that have been canned at home! Examples include home canned vegetables or home canned meats.
*Application shall be submitted at least 5 calendar days prior to the date of the event
List the name, address and contact information for each food vendor for this sponsored event in the space below. Use a separate sheet for additional vendors, if needed. Attach a menu for each vendor for those food items to be sold at event.
Permit No. (if applicable)
Name of Est.
Address, City, ST, Zip
Manager/POC Phone
_______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
Signature
Date
................
................
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