City Clerk Business Licensing
1800 W. Old Shakopee Road
Bloomington MN 55431-3027
PH 952-563-8728
TTY 952-563-8740
Temporary Food
License Application
Please submit all applications 10 working days before the event.
Continued on page 2
Complete the chart below for all food and beverages to be served. Add additional pages if needed. Food must be from a
commercial source. Home-prepared foods are not allowed. Slowcookers/crock-pots are not allowed. Mechanical refrigeration
and hot holding equipment are required for events lasting longer than four hours.
Applicant name Business name
Applicant phone Email
Applicant address City Zip
Event Organizer Phone Email
Name of event
Date(s) One day only
Multiple days
Food service time: (Start-
Location and address of event
Will the event be open to the public? Yes No
Number of people
On-site person in charge of food service at event
Email Phone
Hot food: Purchased from: Preparation location: Equipment used to
cook/heat food:
Equipment used to
keep food hot
(above 140° F):
Cold food: Purchased from: Preparation location: Equipment used to
prepare food:
Equipment used to
keep food cold
(below 41° F):
Shelf-stable food and
Purchased from: Preparation location: Equipment used to prepare food:
57_040 (09/18) pg 1 of 2
Employees must be able to wash their hands with warm running water and liquid hand soap. Paper towels must be provided
to dry hands. Hand sanitizer is not a substitute for hand-washing.
What hand-washing facilities will be provided in the stand?
Hand-washing sink Container with spigot lled with warm water
How will you minimize direct hand contact with ready to eat foods? (gloves, utensils, etc.) _____________________________
What sanitizer will be provided to wipe down food contact surfaces and sanitize utensils?
Chlorine (bleach) 50-100 ppm Quaternary ammonium 200-400 ppm Not applicable (no food handling or only
prepackaged food)
Provide test strips for the chemical you choose. Check online to order them.
What facilities will be provided for dishwashing? (if applicable) __________________________________________________
What single-service utensils will be used? __________________________________________________________________
What toilet facilities will be provided for food handlers? _________________________________________________________
Provide the following unless foods are prepackaged:
A food thermometer to test food temperatures (0-220° F).
• Hats or hairnets for all people involved in food preparation or dishwashing.
An overhead covering for all food preparation or service areas outdoors, except over grills and fryers.
A oor for all food stands outdoors such as concrete, asphalt, plywood or mats.
A Class K re extinguisher if cooking with grease.
Will there be a tent greater than 200 square feet or a canopy greater than 400 square feet? Yes No
If yes, a separate permit is required from the Fire Prevention Division, 952-563-8933.
If the event is at a public school, attach a copy of the school permit.
Will alcohol be served at the event? No Yes, Liquor Caterer _______________________________________________
Liquor Caterers must notify the Licensing Examiner at least 7 days prior to the event, 952-563-4923.
Based on the information provided herein, I understand that a temporary food license is required for this event. I further under-
stand that my application will be considered only for the food and beverage specied. The Environmental Health Specialist must
be advised of any deviations or changes to the menu.
Applicant’s signature Date
For office use only
This application is approved only for the operation as specied above.
Additional approval is required for any deviations.
n Multiple vendor: $928
Please select license type:
n 1 - 3 Days complex: $173
n 4 - 21 Days complex: $288
n 1 - 3 Days simple: $49
n 4 - 21 Days simple: $115
Environmental Health Specialist Date
57_040 (09/18) pg 2 of 2
Retain page 3 for reference.
Where will food be stored prior to the event? ________________________________________________________________
When will food be prepared? ____________________________________________________________________________
What time will food arrive at the event? ____________________________________________________________________
Please print out and sign here in ink.
Clear Form and Start Over
Temporary Food
License Requirements
Information Sheet
The Environmental Health Division must be notified of all
events that involve food service and sampling of food.
Contact our office at least 10 business days prior to an
event to determine if a Temporary Food License is
necessary. If a license is necessary, an application and a
short interview process will follow. The Bloomington City
Code adopts the Minnesota Food Code. Final approval
must be obtained befo
re the event can take place.
Sanitary Facilities
1) Areas of food preparation, service or storage must provide
protection against adverse weather, wind or dust. Provide
a floor such as plywood or mats if set up on grass.
2) Water must be obtained from a public supply and must
be stored in a sanitary manner.
3) Wastewater must be discharged directly to an approved
system or holding tank.
4) Garbage/refuse must b
e stored in a covered, leakproof
container away from food activities.
5) Handwashing facilities must
be provided with running
water (a container with a
spigot is permitted),
nailbrush, pump soap
and paper towels.
Discharge water into a
holding vessel or waste
1) Food/ice must be obtained from an approved commercial
source. Home prepared food is not
2) Food/ice must be covered and stored in a sanitary
manner at least six inches above the floor/ground.
3) Potentially hazardous food must be held at 4 F or
colder or at 140° F or hotter. Mechanical refrigeration
must be used for events over four hours.
4) Potentially hazardous food previously heated must be
reheated to 165° F and held at 140° F or hotter.
5) Ice used for storing canned/bottled
beverages must be
self-draining and not be consumed.
6) Self-service food condiments must be individually
packaged or dispensed from an enclosed dispenser.
7) No bare hand contact with ready to eat foods. Use
utensils or gloves to handle food that will not be cooked.
8) Mark time when using time alone as the public health
9) A food thermometer must be provided to test food
temperatures (0-220° F).
1) Employees must wash their hands before handling
food, after handling raw meat and after eating, drinking,
smoking or using the toilet.
2) Employees must be free of communicable disease,
illness or infection. Employees hands must be free of
cuts, bandages or jewelry.
3) No eating, drinking, smoking or chewing gum in the
food prep/service area.
4) Employees must wear caps, hairnets or other effective
ir restraints during food activities and warewashing.
Employees must wear clean clothes and aprons over
outer garments.
Food equipment/utensils
1) Equipment/utensils must be commercial-grade and
NSF-approved. Crock pots are not
2) Food contact surfaces must be clean and sanitized
before each use.
3) Sanitizing solution (50-100 ppm chlorine or
200-400 ppm quaternary ammonium) must be used for
sanitizing surfaces and dishes. Wet wiping cloths must
be stored in a sanitizing solution. Provide appropriate test
4) Equipment/utensils must be stored in a sanitary
manner at least six inches above the floor/ground.
5) Dishes/po
ts/pans/utensils must be washed, rinsed with
clear water, sanitized and air-dried. Towel drying is not
permitted. Provide three labeled buckets big enough to
accommodate the largest utensil.
Potentially hazardous food: food that supports the
growth of bacteria. Examples include cooked or raw
animal foods (beef, pork, chicken, hotdogs, etc.). Heat
treated food from plants (cooked rice, potatoes, noodles,
vegetables). Cut melons such as watermelon, cantaloupe
and honeydew. Garlic and oil mixtures. These foods must
be kept at proper temperatures or you must use time as a
public health control.
Community Development
Environmental Health
1800 W. Old Shakopee Road
Bloomington MN 55431-3027
PH 952-563-8934
FAX 952-563-8949
TTY 952-563-8740
web_57rrfoodlic pg 1 of 1 (04/18)
1. Wash
warm water
2. Rinse
3. Sanitize
bleach 50-100 ppm
or quaternary
200-400 ppm.
4. Air dry