Marshfield Board of Health
870 Moraine Street
Marshfield, Ma. 02050
781-834-5558
Fax 781-837-6047
Permit #______ Fee ____ 2008 MARSHFIELD FAIR
AUGUST 15
- 24
APPLICATION FOR TEMPORARY FOOD ESTABLISHMENT PERMIT
*Applications will not be accepted unless a copy of your current food certification(s)
is enclosed.
PLEASE PRINT CLEARLY
Name of Establishment:_____________________________________________
Name of Operator:_________________________________________________
Complete Mailing
Address:__________________________________________
Town:________________________ Zip: _____________
Phone:______________________ Cell Phone ___________________________
Booth Location:____________________________________________________
Dates & Hours of Operation:__________________________________________
Menu: List all food items proposed to be prepared and served
________________________________________________________________________________________________________________________________________________________________________________________________
Will all foods be prepared at the temporary food establishment booth? Y N
If no, attach a copy of the agreement with the licensed food establishment where the food will be prepared,
including dates and times of food preparation.
Describe how food will be safely transported to the event.
______________________________________________________________________
List sources if serving meat/poultry/seafood/shellfish (Shellfish tags must be maintained for 90 days)
______________________________________________________________________
List water source and storage method________________________________________
How will wastewater be stored and disposed?_________________________________
______________________________________________________________________
How will garbage be stored and disposed?____________________________________
STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the
above, without prior approval from the Board of Health, may nullify final approval.
Signature(s)_________________________________________
Date: _______________
Fees: 1-10 days $10.00/day Frozen dessert: $45.00
Each additional day over 10 $5.00/day Non-profit: $30.00
APPLICATION WILL NOT BE ACCEPTED UNLESS IT IS COMPLETE !
Approval of these plans does not indicate compliance with any other code, law or regulation that may be required.
It further does not constitute approval for operation. A pre-opening inspection of the establishment, with
equipment in place and operational, will be required to determine compliance.
Approval_________________________ Date:__________________
Disapproval_______________________ Date:__________________
Reason for disapproval ___________________________________________________
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