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CITY OF DANBURY HEALTH & HUMAN SERVICES DEPARTMENT (City of Danbury)

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CITY OF DANBURY
HEALTH & HUMAN SERVICES DEPARTMENT
155 DEER HILL AVENUE, DANBURY, CONNECTICUT 06810
Central Health Office Social Services Office
203 - 797-4625 203 - 797-4569
Fax 796-1596 Fax 797-4566
License Application for Itinerant Food Vendor
Application for a license to operate a mobile food service establishment within the territorial limits of
the City of Danbury (application must be completed for every mobile food service vehicle)
Please check appropriately: New Operation Change of Ownership License Renewal
Equipment Type: Truck Van Trailer Cart
Trade Name: _______________________________________________________________________
Vehicle License Plate #: Color:______________ Year: ______________
Make & Model of Vehicle: VIN#:
Owner of Vehicle: ___________________________________________________________________
Address: ___________________________________________________________________________
Telephone: _________________________________________________________________________
Email: ____________________________________________________________________________
Name of Qualified Food Operator/s*:____________________________________________________
*Included copies of certificates
Proposed Location/s*:________________________________________________________________
*Locations for operation shall be approved by the Department of Planning & Zoning
Operating Season: Year Round Seasonal
Hours of Operation: Mon: Tues: _____Wed: _____ Thurs: _____ Fri: _____Sat: ____ Sun: _____
Water Source: Public Private
Food Vendor Questionnaire
What type of sanitizer is used? ______________________________________________________
Are test papers and/or kits available for checking sanitizer concentration? YES NO
Is a Three compartment sink available? YES NO
Are handwashing facilities available? YES NO
Describe setup if not a fixed handsink: ___________________________________________________
Is hot and cold running water under pressure available at each handwashing sink? YES NO
Will non-latex disposable gloves and/or utensils and/or food grade paper be used to minimize handling
of ready-to-eat foods? ________________________________________________________________
Complete Menu included? YES NO
Where will food products be purchased? (All items must be from an approved source)_____________
__________________________________________________________________________________
__________________________________________________________________________________
Where will food be stored outside of operation hours? ______________________________________
__________________________________________________________________________________
Food Preparation (Describe): __________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
List types of cooking equipment: _______________________________________________________
__________________________________________________________________________________
How will hot PHF's be maintained at 140°F (60°C) and above during holding for service? Indicate type
and number of hot holding units:________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please indicate how PHF’s will be cooled to 45°F (5°C) within 6 hours (140°F to 70°F in 2 hours and
70°F to 45°F in 4 hours).
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of
the food reach a temperature of at least 165°F for 15 seconds. Indicate type and number of units used
for reheating foods.__________________________________________________________________
__________________________________________________________________________________
Is adequate and approved freezer and refrigeration available to store frozen foods at 0 F and below, and
refrigerated foods at 45°F (5°C) and below? YES NO
How will cold PHF's be maintained at 45°F (5°C) and below during holding for service? Indicate type
and number of cold holding units.
__________________________________________________________________________________
__________________________________________________________________________________
Are toilet facilities available? (Describe location available to operator)__________________________
__________________________________________________________________________________
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CITY OF DANBURY HEALTH & HUMAN SERVICES DEPARTMENT (City of Danbury)

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Completed 18 January 2021

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