Mobile Unit Commissary Use Verification Form (Portland, Oregon)

This is the official Mobile Unit Commissary Use Verification Form from Multnomah County Environmental Health Services. You can fill it in its original layout in your browser or with an AI assistant, then download it to review, sign and submit to the agency.

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Form details

Issuer: Multnomah County Environmental Health Services
Jurisdiction: Portland, Oregon
Type: Food truck and mobile vending permits
Questions: 67
Last mapping review: 2026-10-02

Official blank PDF from Multnomah County Environmental Health Services ↗

What this form asks

Mobile Unit: Mobile Name
Licensed Food Service Facility: Restaurant Name
Mobile Unit: Location
Licensed Food Service Facility: Address
Mobile Unit: Operator Name
Mobile Unit: Email
Licensed Food Service Facility: Contact Person
Licensed Food Service Facility: Phone
Mobile Unit: Phone
Licensed Food Service Facility: Facility #
Mobile Unit: Facility #
Licensed Food Service Facility: Licensed County
Commissary Owner's Printed Name
Commissary Owner: Date Signed (date)
Mobile Unit: Class of Mobile (choose one)
Licensed Food Service Facility: Facility Type (choose one)
Start Date of Operation (M/YR)
Operator Information: Address of Mobile
Operator Information: Zip
Operator Information: POD Name
Operator Information: Operator Name
Operator Information: Phone
Operator Information: Home Mailing Address
Commissary Information: Restaurant/Commissary Name
Commissary Information: Contact Name
Commissary Information: Phone #
Commissary Information: Address (Street, City, State, County, Zip)
List all operations that will occur at the commissary
How will foods be transferred from commissary to mobile
List all operations that will occur in the mobile
Applicant: Date Signed (date)
Applicant: Print Name
Operator Information: Email
Operator Information: Social Media
Operator Information: Mobile Unit Name
Operating Days and Hours: Operating All Days (checkbox)
Months of Operation: All Year (checkbox)
Months of Operation: Mar (checkbox)
Months of Operation: Apr (checkbox)
Months of Operation: May (checkbox)
Months of Operation: Jun (checkbox)
Months of Operation: Jul (checkbox)
Months of Operation: Aug (checkbox)
Months of Operation: Sept (checkbox)
Months of Operation: Oct (checkbox)
Months of Operation: Nov (checkbox)
Months of Operation: Dec (checkbox)
Hours of Operation: Sun From
The licensed restaurant/kitchen is owned by the same owner as the mobile owner (choose one)
I will be conducting food service activities at the commissary (e.g. dish washing and/or food preparation such as thawing, cooking, cooling, storage) (choose one)
Drop off/pick up: I will be arriving daily at the licensed kitchen just to pick up clean utensils prior to operating and drop off used utensils at the end of the day (choose one)
Class of Mobile this Commissary Will Be Servicing (choose one)
Hours of Operation: Sun To
Hours of Operation: Mon From
Hours of Operation: Mon To
Hours of Operation: Tue From
Hours of Operation: Tue To
Hours of Operation: Wed From
Hours of Operation: Wed To
Hours of Operation: Thur From
Hours of Operation: Thur To
Hours of Operation: Fri From
Hours of Operation: Fri To
Hours of Operation: Sat From
Hours of Operation: Sat To
Months of Operation: Jan (checkbox)
Months of Operation: Feb (checkbox)

Review, sign and submit

PaperPorter fills the form but does not submit it or approve anything. Signatures, initials and staff-only areas are left for the right person. Confirm current fees, attachments and filing instructions with Multnomah County Environmental Health Services.

Other Portland forms

Mobile Unit: Restroom Agreement Form Multnomah County Environmental Health Services
Application for Sidewalk Vending Cart Permit Portland Bureau of Transportation
Warehouse Operating License Application Multnomah County Environmental Health Services
Mobile Unit: Wastewater Disposal Form Multnomah County Environmental Health Services
Business Registration Form (Form REG): City of Portland Business License Tax, Multnomah County Business Income Tax, Metro SHS Business Income Tax City of Portland Revenue Division
Mobile Food Unit Plan Review Application Packet Multnomah County Environmental Health Services
Mobile Food Unit Operating License Application Multnomah County Environmental Health Services

Food truck and mobile vending permits in other places

Frequently asked questions

Does PaperPorter submit this form?

No. You download the completed PDF, then review, sign and submit it to Multnomah County Environmental Health Services yourself.

Can I fill it without an AI assistant?

Yes. Fill it in your browser and download the completed PDF. An assistant such as ChatGPT or Claude can also ask you the questions and fill it for you.