KIRKLEES COUNCIL F1 3

ENVIRONMENTAL SERVICES

APPLICATION FOR REGISTRATION OF FOOD ESTABLISHMENTS

(Regulation (EC) No 852/2004 on the Hygiene of Foodstuffs)
This form should be completed by food business operators in respect of new food business establishments and submitted to
Kirklees Council, Environmental Services, Flint Street, Fartown, Huddersfield HD1 6LG 28 days before commencing food
operations. Depending on the type of activities carried out, certain food business establishments are required to be approved
rather than registered. If you are unsure whether any aspect of your food operations would require your establishment to be
approved, please contact the Food Safety Team on 01484 414739

1. Address of establishment (or address at which moveable premises are kept):

16 Heys Gardens, Thongsbridge, Holmfirth Post Code: HD9 7NS

2. Name of food business (trading name):
Telephone No: Email Address:
07545253115 adyson2@talktalk.net
3. Full name of food business operator:
Date of Birth:
18/12/1952 Alice Dyson
4. Address of food business operator:

Post Code:
Telephone Number: 07545253115 Email Address: adyson2@talktalk.net HD9 7NS
5. Type of establishment: (Please tick all the boxes that apply)
Farm Shop Food manufacturing/processing Packer
Importer Wholesale/cash and carry Distribution/warehousing
Retailer Moveable premises (eg ice cream van) Restaurant/café/snack bar
Catering Staff restaurant/canteen/kitchen Hotel/pub/guest house
Market Hospital/residential home/school Private house used for food business
Market Stall Food Broker Seasonal Slaughterer
Takeaway Other please give details: .................................................................................

6. Type of business:
Sole Trader Partnership Limited Company (if limited company
please complete section 7)

Other please give details: .................................................................................................................................

7. Limited company name: Company No:

Registered Office address:

Post Code:
8. Food-related activities (please give full details of ALL food-related activities):

Preparing jams and pickles

9. Number of vehicles or stalls kept at, or used from, the
establishment and used for the purposes of preparing, 5 or less 6-10 11-50 51 plus
selling or transporting food:
10. Water supplied to establishment: Public (mains) supply Private supply
11. Name of Manager if different to operator:
12. If this is a new food business, date intended to open:
17/05/2021
13. Opening times daily.
Seasonal period if applicable 9-12am
14. Number of people engaged in the food business: 0-10 11-50 51 plus
Count each part-timer (ie 25 hrs per week or less) as ½
It is an offence to give false or incomplete information
Signature of food business operator: Date:
03/05/2021
Name (in BLOCK CAPITALS):
ALICE DYSON
Position in company/business:
Manager
After this form has been submitted, food business operators must notify Environmental Services of any
changes to the activities stated above within 28 days of the changes taking place.