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Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
www.tooelehealth.org
Mobile Food Truck Permit Application
Please put N/A for any fields that are not applicable
Business Information
Organization Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Name of Business Owner
Phone Number
License Plate Number
Primary Permit Tier 1:
$200.00
Select:
Item Subtotal:
$0.00
Primary Permit Tier 2:
$350.00
Select:
Item Subtotal:
$0.00
Tier
Two or fewer low-risk TCS Ingredients
More than two TCS Ingredients
Certified Food Safety Manager is required for Tier 2
Commissary Name
Contact Name
Address
Phone
If you have additional documents to send, please email them to eh@tooelehealth.org.
Total:
$0.00
Signature of Applicant
Date
Payment Information:
Method of Payment:
Credit/Debit Card
eCheck
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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