Mobile Food Vending Unit-Plan Submission Guide - City of ...

Office of Food Protection321 University Avenue, 2 nd FloorPhiladelphia, PA 19104http://www.phila.gov/health/Environment/FoodProtection.htmlMOBILE FOOD VENDING UNIT PLAN REVIEW/CHANGE OF OWNERSHIPAPPLICATION1) Mobile Vending Unit’s Trade Name: ___2) Licensee Name (owner, partnership, or corporation): ___________________________________________3) Mailing Address, City, State, Zip: __________________________________________________________4) Food Vending Location(s)/Area(s): _________________________________________________________5) Home Phone: _________________________ Cell Phone:__________________________________Fax: _________________________________ Email: ______________________________________6) Primary Language Spoken _______________Establishment Emergency Contact Name:_______________________________________________Establishment Emergency Contact phone #: _______________________________________________CHOOSE ONE OF THE FOLLOWING:____ Change of Ownership Only / Ownership Change Date: ____________________Mobile Food Unit Philadelphia Health Dept. ID# (THIS IS REQUIRED.)_________Previous Establishment’s Name:________________________________________________________(New ownership of an existing ongoing food establishment operation without modification to the foodequipment and/or food handling activities. Establishment floor plans & equipment details are not required.Required Fees: $255 IN MONEY ORDER OR CASHIER’S CHECK only payable to PhiladelphiaDepartment of Health- EHS”.)_____ Modification Work Start Date:_____________Work Completion Date:_______________Modification includes the remodeling or alteration of an existing mobile food vending unit or change that affects theway the establishment operates, which may or may not include installation of equipment, replacement orrelocation of permanently installed equipment, change in menu or operational procedure.Provide a description of what has been modified.__________________________________________________________ New Unit (Includes units not previously approved by the Philadelphia Health Dept.)I certify that the information provided on this application is correct to the best of my knowledge. I understand thatincomplete or illegible application will be returned unprocessed.Applicant Name (Print)_____________________________________ Title:____________________Applicant Signature: __ _____ Date: ___________________6