11-71-T35

Temporary Event Food Notification Form - Event Organiser

Name of Event *

Event Location *

Date of Event

Set up time

Start time

Finish time

Number of food outlets at event (please include stalls, mobile vans and those operating from permanent premises).

Temporary Stalls *

Mobile food Vans *

Permanent Premises *

Ensure all food outlets complete the individual food outlet notification form

Event Organiser Details

Name of company or body responsible for the event *

Business Address *

Street address *

City *

State *

Postcode *

Postal Address

Business Phone *

Email

Contact Name *

Contact Email

Mobile Phone *

After Hours Contact

Please return the completed form to City of Port Lincoln four (4) weeks prior to the event. It is requested that event organisers collect the 11-36-T36 Individual Food Outlet Form and send them through at least one (1) week before the event date.

Food Business Notification

Please provide the food / drink stalls that will be at the event, including their Food Business Notification Number. For more information regarding this, please go to: http://www.portlincoln.sa.gov.au/foodsafety or contact Council's Environmental Health Officers on (08) 8621 2300 for further information.

Stall Trading Name *

FBN *

Contact Person *

Contact Number *

Contact Email *

Food Safety Supervisor (if required)

I declare that all the information I have supplied is true and correct. I acknowldge that personal information provided may be used by the City of port Lincoln for the purpose of Council business, as specified in Councils Privacy Policy. *