Walmart #2740 Fuel Station in Tampa

Comments: Thank you for submitting your food establishment permit application. To complete the application process, you must remit payment in full. To expedite the processing of your food permit application, electronic online payment is available at https://foodpermit.fdacs.gov. Follow the instructions on the portal page for payment processing. Payment by check or money order is also accepted, but must be made payable to FDACS and remitted to Florida Department of Agriculture and Consumer Services, PO Box 6720, Tallahassee, FL 32314-6720. Please note that payment by check or money order may delay the processing of your food permit application. Permit fees must be paid in full before your application can be processed further. Failure to pay any permit fees in full will result in the denial of your permit and you may be subject to administrative penalties if you are found operating without a valid food permit, which is a violation of Section 500.12(1)(a), Florida Statutes. If you are found to be in violation of this provision, the Department may impose up to a $5,000.00 fine against you and/or seek administrative action to close your business. The Minimum Construction Standards checklist has been used in accordance with 500.12(2)(a) Florida Statutes by the food safety inspector to determine compliance before obtaining a food permit. Payments can be made online at https://foodpermit.fdacs.gov or can be mailed to Florida Department of Agriculture and Consumer Services, P.O. Box 6720, Tallahassee FL 32314-6720. Checks and money orders are to be payable to Florida Department of Agriculture and Consumer Services. All payments must include the Food Establishment number and reason of payment type in the memo section of the check or money order. Employee Health and Foodborne Illnesses handout provided to person in charge. Request#5077005. ACKNOWLEDGMENT I acknowledge receipt of a copy of this document, and I further acknowledge that I have verified the location and mailing addresses on the first page of this document are correct, or I have written the correct information on the first page of this document. (Signature of FDACS Representative) STEFANIA SKULADOTTIR-SIEBERT, SENIOR SANITATION AND SAFETY SPECIALIST (Signature of Representative) HENRY RIVERA, PERSON IN CHARGE Print Name and Title LIZ JANET OREJON, SANITATION AND SAFETY SPECIALIST FDACS 14205 Rev. 07/13 Page 3 of 3 FDACS 14205 Rev. 07/13 Page 1 of 1