HomeMy WebLinkAboutlscfo-registration-form-ada Ronald Browder
Director
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LIMITED SERVICE CHARITABLE FEEDING OPERATION (LSCFO)
REGISTRATION FORM
ORGANIZATION INFORMATION
Organization name:
Physical address: City: CA Zip:
Site representative: Phone: ( )
Internet website: Email:
FOOD OPERATION
Type of Food Operation (check all that apply):
*Distribution of 100% prepackaged, shelf-stable foods (Category 1)
*Distribution of 100% prepackaged, shelf-stable and perishable foods (Category 2)
Reheat or portion commercially prepared foods with no further processing (Category 3)
Heat, portion, or assemble a small volume of commercially prepared foods or ingredients that
are not prepackaged (Category 4)
* If you only distribute prepackaged foods in conjunction with a local food bank, you do not need to fill out this
form. Contact your local food bank for more information.
FOOD SOURCES
Food Sources: Buy food Receive donated food
List all food sources, restaurants, grocery stores, or other permitted kitchens that you will obtain
food from.
FOOD DISTRIBUTION
Frequency of Food Distribution: Indicate your operating days and hours.
Distribution Locations, if Different Than Physical Address:
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Office Use Only:
Registration # Approved By: Date:
TYPICAL MENU ITEMS AND PREPARATION ACTIVITIES
Fill out the following if your Limited Service Charitable Feeding Organization provides any
open food (categories 3 and 4). Note that further evaluation of processes may be
necessary to determine if your operation is consistent with registration requirements.
Ex: Pre-made pasta salad. Open container and serve with serving spoon. No further preparation required.