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PO Box C Laramie, WY 82073 Phone: [PHONE REDACTED] CITY OF LARAMIE ENVIRONMENTAL HEALTH TEMPORARY FOOD LICENSE APPLICATION Application must be submitted 5 business days prior to event with payment or license may not be issued on time Event: Location of Event: Dates of Event: Begin Time: End Time: Organization Represented: Applicant’s Name: Applicant’s e-mail address: Contact Phone: Person(s) in charge at Food Service Site: Location of Advanced Preparation: Times of Advanced Prep: Type of Thermometer Available (if applicable; analog, digital): Water Source: Municipal Wastewater Disposal: Sewer Holding Tank: Describe: Cold Holding Equipment Cooking Equipment Hot Holding Equipment Reheating Equipment Please list all foods to be served: If food is transported: Provide length of time in transport, and how it is kept hot or cold: Hand Washing Facilities: Plumbed Sink: Gravity Flow Container: Note: Restrooms do not qualify as a hand washing sink. Utensil Washing Facilities: Plumbed 3-compartment sink: Adequate Supply of Utensils for Day: Garbage Disposal: Cans: Dumpsters: I hereby consent to inspection by the City of Laramie Environmental Health and acknowledge that issuance and retention of this license is contingent upon satisfactory compliance with the food safety regulations. I have viewed the “Temporary Food License Guidelines” PowerPoint and understand the materials presented. Our booth agrees to abide by these guidelines. If our booth fails to meet these guidelines, I understand that our food service booth may be forced to cease operation immediately. By signing below, I certify that I am authorized by the organization to act as their agent, and agree the booth will abide by Food Code Regulations. Temporary events shall not exceed 14 consecutive days for a single event and location. Temporary Sampling events shall not exceed 14 individual days over 3 consecutive months for a single location. APPLICANT’S SIGNATURE: DATE: APPROVING CITY OFFICIAL: DATE: FOODS NOT LISTED BELOW WILL NOT BE ALLOWED TO BE SERVED FOR OFFICE USE ONLY Amount Paid: Check: Non-Profit ID Received By: All paid applications $50.00 With Non-Profit ID# $0.00 Make checks payable to: WY Dept. of Agriculture, Consumer Health Services FOOD ITEM AND SOURCE (Where are you getting it) COOKING/PREPARATION PROCEDURES HOLDING HOT / COLD SERVING HOT/ COLD