COOK COUNTY DEPARTMENT OF PUBLIC HEALTH



COOK COUNTY DEPARTMENT OF PUBLIC HEALTH

ENVIRONMENTAL HEALTH SERVICES

2121 Euclid Avenue, Rolling Meadows, Il 60008

847-818-2844 phone

North District fax 847-818-2464

knagaraj@ (Kamala Nagaraj)

Application for Farmer’s selling only uncut produce, pet food, packaged meats, eggs, honey

Name of event:

Location or address of event:

Name of applicant:

Telephone number(s):

List all items that will be sold:

Please provide all licenses (egg license, pet food license, meat broker license)

Please provide a refrigerator or freezer for meats and eggs.

Please provide the source of mushrooms.

Are you sampling your produce? Yes No

(Do you have a sampling license from the State of Illinois) Yes No

[pic]Applicant’s Signature Date

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