APPLICATION FOR EXEMPTION TO OFFER BAKED GOODS FOR SALE APPLICATION FOR PERMIT TO OPERATE TEMPORARY FOOD ESTABLISHMENT PLEASE COMPLETE AND RETURN TO THE ENVIRONMENTAL HEALTH FIELD SERVICES (EHFS) OFFICE LOCATED IN THE COUNTY IN WHICH THE TEMPORARY FOOD ESTABLISHMENT WILL BE OPERATED. EHFS New Castle County EHFS Kent County EHFS Sussex County Limestone Prof. Ctr., Thomas Collins Building 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 Fax: 302-856-5065 1. Applicant Name: _______________________________________________ Phone #: ________________________ Applicant Mailing Address: _______________________________________________________________________ City: _______________________________ State: _______________ Zip Code: _________________________ 2. Religious/Charitable Organization’s Name: _______________________ Phone___________________________ 3. Location of Stand: ________________________________________________ 4. _________________________ Date(s) of Operation 4. Proposed Baked Goods: ____________________________________________________________________________ 5. Additional comments: _____________________________________________________________________________ _____________________________________________________________________________ Examples of baked goods that are considered not potentially hazardous include, but are not limited to, cookies, cakes, brownies and fruit filled pies. Cakes and pies must be sold as whole units, and not cut or portioned on site for individual service. All foods must be adequately protected and handled to prevent contamination. Examples of foods considered to be potentially hazardous may not be offered for sale or service under this exemption are those that contain custards or creams, certain pies such as pumpkin, and any item requiring refrigeration to ensure food safety. Consumer is informed by a clearly visible placard at the sales or service location _____________________________________________________ _________________ Signature and Title of Applicant DATE FOR OFFICIAL USE ONLY ________ Approved ________ Disapproved _______________________________________ _____________ ________________ Environmental Health Field Services Representative Date Permit Number Doc. No. 35-05-20/08/04/12