Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
Plan Review Application for
Electronic Smoking Device Establishment
Please put N/A for any fields that are not applicable
Plan review fee, Sec. 8 Receipt#
Floors/walls/preparation surfaces/equipment shall be smooth, non-absorbent & easily cleanable
Storage area for E-liquid and Nicotine, Sec. 18.104.22.168
Storage area for chemicals, Sec. 22.214.171.124
Standard Operating Procedures (SOP), Sec. 5.4.3
SOP training log, Sec. 5.4.3
E-liquid documentation, Sec. 126.96.36.199.1
If you have additional documents to send, please email them to firstname.lastname@example.org.
All of the above statements are true. I understand that any false information on this application may be cause for denial or revocation of my Electronic Smoking Devise Establishment Permit. Permits may be revoked or suspended for violation of
Tooele County Health Department Regulation #18.
Permits are non-transferable.
Electronic Smoking Device Plan Review:
'Please Select Method of Payment to Continue'
Method of Payment:
Update Name from Personal/Organizational Information
Name on Account:
Name on Card:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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