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BOSTON
INSPECTIONAL SERVICES DEPARTMENT
DIVISION OF HEALTH INSPECTIONS
1010 Massachusetts Avenue Boston, MA 02118
TEMPORARY
FOOD SERVICE APPLICATION
NAME OF
APPLICANT: ______________________________ PHONE NO. ______________
NAME OF OWNER
(If different): ________________________________________________
ADDRESS OF
APPLICANT: ____________________________________________________
NAME OF EVENT:
NEPC Produce
& Floral Expo 2008
ADDRESS OF
EVENT: Boston
Convention Exhibition Center
Boston, MA
SPECIFY DATES
& TIMES OF EVENT:
April
9, 2008, 7:30 a.m. - 4:00 p.m.
SIGNATURE OF
APPLICANT:
__________________________________________________
FOOD
TO BE SERVED
LIST ALL FOOD
THAT WILL BE SERVED
AND THE ESTABLISHMENT WHERE THE FOOD WAS PURCHASED:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
PREPARATION/COOKING
FACILITIES
ON SITE:
YES ___ NO ___ IF YES, DESCRIBE FACILITIES AND EQUIPMENT
________
___________________________________________________________________________
OFF
SITE: YES ___ NO ___ IF YES, WHERE?
__________________________________
TYPE OF
TABLEWARE: PAPER PRODUCTS ___
CHINA ___
DESCRIBE WARE WASHING FACILITIES FOR UTENSILS AND EQUIPMENT:
___________________________________________________________________________
FOOD
PROTECTION
DESCRIBE
EQUIPMENT AND MEANS OF TRANSPORTING FOOD HOT (140° F OR ABOVE),
COLD (45° F
OR BELOW): ____________________________________________________
___________________________________________________________________________
REFRIGERATION: REQUIRED ___
NOT REQUIRED ___
METHOD OF
REFRIGERATION: ________________________________________________
___________________________________________________________________________
TYPE OF
COOKING/HOT HOLDING EQUIPMENT: __________________________________
___________________________________________________________________________
DESCRIBE
MEASURES TO PROTECT FOOD FROM CONTAMINATION
DURING PREPARATION, STORAGE AND
DISPLAY: _______________________________
___________________________________________________________________________
GARBAGE
AND RUBBISH
DESCRIBE MEANS
FOR STORAGE AND DISPOSAL: ______________________________
PERSONNEL
AND FOOD HANDLING PRACTICES
NUMBER OF FOOD
HANDLERS: ___________
LOCATION OF HAND WASHING FACILITIES:
On site - BCEC
LOCATION OF
TOILET FACILITIES:
On site -
BCEC
HAIR
RESTRAINTS PROVIDED: YES ___
NO ___
DISPOSABLE
GLOVES PROVIDED: YES ___
NO ___
OFFICE
USE ONLY
INSPECTOR’S
RECOMMENDATIONS: ___________________________________________
___________________________________________________________________________
ACTION
TAKEN
PERMIT DENIED:
_____ REASON FOR DENIAL:
__________________________________
___________________________________________________________________________
PERMIT
GRANTED: _____ CONDITIONS:
_______________________________________
___________________________________________________________________________
INSPECTOR:
_____________________________ DATE:
__________________________
Fax completed form
to the NEPC Office at (781) 273-4154
If you have any questions or require additional
information,
please contact Laura Sullivan at (781) 273-0444.
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