SOMERSET COUNTY HEALTH DEPARTMENT		APPLICATION FOR SPECIAL FOOD EVENT
Environmental Health Section
7920 Crisfield Hwy.
Westover, Maryland 21871	443-523-1730

Complete application and submit it with $50.00 license fee to the Somerset County Health Dept. for approval at least one(1) week
prior to the date of the event. (No fee will be assessed to a bonafide, nonprofit organization.)

Event__________________________________________________________________________

Location of Event______________________________________________________________

Date(s)______________________________  Serving Hours___________________________

Contact Person_________________________________________________________________

Address______________________________  Phone___________________________________

       ______________________________  Signature_______________________________
FOODS TO BE SERVED

Source of Foods to be Served___________________________________________________


Source of Ice and Water________________________________________________________

Method of:
   Storage(Prior to cooking)___________________________________________________

   Cooking_____________________________________________________________________ 

   Refrigeration________________________ Hot Holding___________________________

Will any food be prepared a day or more in advance of serving?
If yes, explain which foods and when preparation and serving will take place)
_______________________________________________________________________________
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Approved__________________________________ Date_______________________

Expires_______________________________________________________________