APPLICATION TO OPERATE A LIMITED FROZEN DESSERT STAND – (LFDS) PLEASE COMPLETE AND RETURN TO THE ENVIRONMENTAL HEALTH FIELD SERVICES (EHFS) OFFICE LOCATED IN THE COUNTY IN WHICH IN THE LIMITED FROZEN DESSERT STAND (LFDS) WILL BE LOCATED. EHFS New Castle County EHFS Kent County EHFS Sussex County Limestone Prof. Ctr., Suite 100 Thomas Collins Bldg Georgetown State Serv. Ctr. 2055 Limestone Road 540 S. Dupont Hwy, Suite 5 544 South Bedford Street Wilmington, DE 19808 Dover, DE 19901 Georgetown, DE 19947 Phone: 302-995-8650 Phone: 302-744-1220 Phone: 302-856-5496 Fax: 302-995-8323 Fax: 302-739-1957 Fax: 302-856-5065 1. Applicant Name: _______________________________________________ Phone #: ________________________ Applicant Mailing Address: __________________________________________________________________________ City: _______________________________ State: _______________ Zip Code: _______________________ 2. Business/Organization Name: _________________________________________ Fax #: ______________________ 3. Location of Stand: __________________________________________________ 4. _________________________ Date(s) of Operation 5. Proposed Menu: ________________________________________________________________________________ 6. Source of Frozen Desserts (including ice): ____________________________________________________________ 7. Source of Water (if applicable): ____________________________________________________________________ 8. Handwashing Facilities (Describe): _________________________________________________________________ 9. Toilet Facilities (type/location): ________________________________if using private facilities, attach written agreement 10. Methods to be used for maintaining proper product temperature. (Hard, frozen to maintain quality and condition): _________________________________________________________________________________________________ 11. List all equipment/utensils to be used (including service items): ___________________________________________ 12. Site where equipment/utensils to be sanitized (if other than stand location): _________________________________ 13. Additional comments: ___________________________________________________________________________ ___________________________________________________________________________ _____________________________________________________ _________________ Signature and Title of Applicant DATE FOR OFFICIAL USE ONLY ________ Approved ________ Disapproved _______________________________________ _____________ ________________ Environmental Health Field Services Representative Date Permit Number Doc. No. 35-05-20/08/07/06