Schedule A: Mobile Vending Operation Support Facility Information Form (Philadelphia, Pennsylvania)

This is the official Schedule A: Mobile Vending Operation Support Facility Information Form from Philadelphia Department of Public Health, Office of Food Protection. 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: Philadelphia Department of Public Health, Office of Food Protection
Jurisdiction: Philadelphia, Pennsylvania
Type: Food truck and mobile vending permits
Questions: 38
Last mapping review: 2026-10-02

Official blank PDF from Philadelphia Department of Public Health, Office of Food Protection ↗

What this form asks

1. Name of Support Facility
2. Name of Support Facility Owner
3. Support Facility Address, City, Zip
4. Support Facility Business Phone
4. Support Facility Email
5. Do you operate from the support facility on a daily basis? (choose one)
5. If No, explain
6. Do you report back to the support facility at the end of the day for all cleaning, servicing operations, and waste disposal? (choose one)
6. If No, explain
7. Hours You Report to the Support Facility: Morning
7. Hours You Report to the Support Facility: Evening
8. Is this support facility inspected by the Philadelphia Health Department? (choose one)
8. If No, Name of the Regulatory Agency That Inspects the Support Facility
9. What fuel source(s) does your operation utilize?
10. Types of Food Sold: Prepackaged food only (checkbox)
10. Types of Food Sold: Cold prepared foods (checkbox)
10. Types of Food Sold: Meat products (checkbox)
10. Types of Food Sold: Water ice/Ice cream (checkbox)
10. Types of Food Sold: Whole fish/Fresh seafood (checkbox)
10. Types of Food Sold: Fresh produce (checkbox)
10. Types of Food Sold: Deep-fat fried foods (checkbox)
10. Types of Food Sold: Hot cooked foods (checkbox)
10. Types of Food Sold: Fruit salad/Smoothie (checkbox)
10. Types of Food Sold: Other (checkbox)
10. Types of Food Sold: Other (describe)
B1. Prepared Food Supplier Name
B1. Prepared Food Supplier: Street Address, City, Zip
B2. Address Where Purchase Receipts Are Kept: Street Address, City, Zip
B3. Support Facility Used For: Food (checkbox)
B3. Support Facility Used For: Water (checkbox)
B3. Support Facility Used For: Supplies (checkbox)
B3. Support Facility Used For: Cleaning of equipment/utensils (checkbox)
B3. Support Facility Used For: Storage of vendor unit (checkbox)
B3. Support Facility Used For: Waste disposal (checkbox)
Applicant Name
Applicant: Date Signed (date)
Support Facility Owner/Operator Name
Support Facility Owner/Operator: Date Signed (date)

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 Philadelphia Department of Public Health, Office of Food Protection.

Other Philadelphia forms

Application for a Special Vending District License City of Philadelphia Department of Licenses and Inspections
Instructions and Application Form, Mobile Food Businesses: Full Plan Review Philadelphia Department of Public Health, Office of Food Protection
Application for a Vendor License City of Philadelphia Department of Licenses and Inspections

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 Philadelphia Department of Public Health, Office of Food Protection 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.