Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Application For Food Handler Permit

Please put N/A for any fields that are not applicable
Applicant's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Date of Birth
Phone Number
Place of Employment
If you have additional documents to send, please email them to eh@tooelehealth.org.

I agree to abide by all local ordinances and laws of the State of Utah governing the service of food and beverage and I understand that failure to do so may result in revocation of my food service worker’s permit and/or other action as the law req

Signature of Applicant
Date

Food Handler Permit:   $20.00   Select:   Item Subtotal:  
$0.00
Food Handler Re-Issue (for lost permits):   $5.00   Select:   Item Subtotal:  
$0.00
Total:
$0.00
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Payment Information:
Method of Payment:
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Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
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Expiration Date:
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