Polk County HHSA - EH Complaint

Polk County HHSA

Non-North Carolina Permitted Food Trucks
Business Name*
Must notify Polk County Health and Human Services Agency 14 days prior to establishing operationsMust have Proof of Current and Valid Permit from the state they are permitted in.Must have Proof of an Inspection within the 12 months prior to operating, must reflect a passing score.Must have proof that the commissary is approved by the permit for resupply.

Owner Name*

First NameLast Name
Owner Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner Email*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Commissary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Operations*
Types of Food Served*
Upload Proof of Current and Valid Permit*

Cancelof
Upload Proof of Passed Inspection*

(Must be within 12 months of operating in Polk County, NC)
Cancelof
Should be Empty: