SCDA Out of State Mobile Food Unit Reciprocity Form.pdf

PDF 632 KB Posted Aug 21, 2025

Attached to: Catered Meals ISO S. C. Army National Guard
Solicitation number: W912QG25QA027
Issued by: Department of the Army South Carolina Army National Guard

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Written by GovTribe AI · Aug 21, 2025

This document is a Mobile Food Unit Reciprocity Request Form from the South Carolina Department of Agriculture (SCDA) Retail Food Safety & Compliance Department. The form enables mobile food units from states adjacent to South Carolina to obtain authorization to sell or serve food within the state, provided they have a valid food establishment permit in good standing and meet Regulation 61-25 requirements for Retail Food Establishments.

The form requires detailed information about the mobile food unit, including contact details, commissary information, operational locations, menu, and equipment. Applicants must submit supporting documentation such as their current permit, previous year's inspection reports, food protection manager certification, and photos of the mobile food unit. The form specifies two types of mobile food units: fully enclosed mobile kitchens (mobile food units/trucks) and limited food service units (mobile food pushcarts), both operating as extensions of a commissary. The completed form is to be submitted to SCDA for review and potential authorization to operate in South Carolina.

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Approved FY25 SCARNG 14 Day Menu.pdf	PDF	Aug 21, 2025
Solicitation - W912QG25QA027.pdf	PDF	Aug 21, 2025

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13/20/24 CPD Form #2109

MOBILE FOOD UNIT RECIPROCITY REQUEST FORM

South Carolina

DEPARTMENT OF AGRICULTURE

RETAIL FOOD SAFETY & COMPLIANCE DEPARTMENT

350 Ballard Court, West Columbia, SC 29172

Hugh E. Weathers, Commissioner

Mobile food units (MFU) from states adjacent to South Carolina may be authorized to sell or serve food within South Carolina. The MFU must have a food establishment permit in good standing in the state of origin and meet minimum criteria specified in Regulation 61-25, Retail Food Establishments. In this document, MFU will refer to any type of mobile food unit, mobile food truck, or mobile food pushcart.

MO B ILE FO O D U NIT (MFU) INFO RM ATI O N

Mobile Food Unit Name

Commissary Address

Storage Address for Mobile Unit � Same as Commissary

Commissary Contact Name

City

State

Zip

Phone

Contact Phone

Mobile

Contact Mobile

Contact Email

Contact Person Name

Permit Holder(s)/Owner(s) Name

24-hour Emergency Contact

LO C A L R E G U L ATO RY AUTH O R IT Y CO NTAC T INFO RM ATI O N

COM MI S S A RY INFO RM ATI O N

Permit No.

Name of Regulatory Authority/Agency

Agency Phone

Agency Mailing Address

Attach a copy of the following documentation:

• Permit

• Inspection Reports from the previous calendar year

• Certified Food Protection Manager or Food Handler’s Certificate for the person in charge during operations

• Photo(s) of the proposed Mobile Food Unit

23/20/24 CPD Form #2109

O PE R ATI O N S INFO RM ATI O N

Operating Location

City

Date

Hours of Operation

Attach a list if more space is needed for operating locations.

List foods that are to be served (menu)

List hot and cold holding equipment used to transport and store time/temperature control for safety foods.

TYPE MANUFACTURER MODEL NUMBER QUANTITY

� Mobile Food Unit or Truck � Mobile Food Pushcart Mobile food units are fully enclosed mobile kitchens that may prepare, cook, or serve time/ temperature control for safety foods as an extension of the commissary.

Mobile food pushcarts are limited food service units that operate as an extension of a commissary.

33/20/24 CPD Form #2109

I, the undersigned, attest to the accuracy of the information provided in this form, and I affirm that the mobile food unit operation will comply with SCDA, Regulation 61-25. It is unlawful for a person to willfully give false, misleading, or incomplete information on a document, record, report, or form required by the laws of the State of South Carolina.

Owner/Person in Charge Name (print) Submittal Date

SC DA U SE ONLY

The Department has reviewed the request and it is: � Authorized � Not Authorized

CommentsSCDA Representative

Date

SCDA Retail Food Safety & Compliance retailfood@scda.sc.gov

350 Ballard Court West Columbia, SC 29172

R E T U R N B Y E M A I L O R M A I L T O

Public information provided on this document is subject to public scrutiny or release.

mailto:retailfood@scda.sc.gov

43/20/24 CPD Form #2109

INSTRUCTIONS FOR COMPLETING

MOBILE FOOD UNIT RECIPROCITY REQUEST FORM

South Carolina

DEPARTMENT OF AGRICULTURE

RETAIL FOOD SAFETY & COMPLIANCE DEPARTMENT

350 Ballard Court, West Columbia, SC 29172

Hugh E. Weathers, Commissioner

Audience: To be completed by the requesting external customer and submitted to SCDA staff to document approval or denial of the request to operate in SC under an out of state permit.

Purpose: This form is for internal use to determine if an out of state mobile unit may operate in SC.

Instructions:

1. Provide the mobile food unit’s name.

2. Provide the mobile food unit’s phone number including the area code.

3. Provide the email address to be used by the mobile food unit.

4. Provide contact person information – including name, email address, and phone number (including area code).

5. Provide the permit holder(s)/owner(s) name.

6. Provide commissary address.

7. Provide the storage address, if different from the above physical address to include city, state, and zip code.

8. Provide the mobile food unit’s permit number and issuing state.

9. Provide local regulatory authority contact information to include name, address, city, state, and zip code.

10. Attach a copy of the mobile food unit’s permit.

11. Attach a copy(ies) of the mobile food unit’s previous calendar year’s inspection reports.

12. Attach a copy(ies) of the Certified Food Protection Manager (CFPM) Certificate or Food Handler’s Certificate for the person(s) in charge. The CFPM is not required for mobile food pushcarts.

13. Attach a menu or list of foods to be served.

14. List the operational information to include location, dates, and times. If needed, attach additional document(s).

15. Identify the type of mobile food unit by checking the box that applies.

16. Provide the type, manufacturer, model number, and quantity of food equipment for hot and cold holding equipment used to store time/ temperature for safety foods. If needed, attach a complete list of equipment as an attachment.

17. Request must be signed by the owner/person in charge. Include the printed name of the owner/person in charge and the date of submittal.

Office Mechanics & Filing: Retention schedule for this form is: 11701 – Retail Food Establishments.

Mobile Food Unit Name:

Commissary Address:

Storage Address for Mobile Unit:

Commissary Contact Name:

City 1:

City 2:

State 1:

State 2:

Zip 1:

Zip 2:

Phone 1:

Phone 2:

Mobile:

Email:

Contact Person Name:

Contact Phone:

Contact Mobile:

Contact Email:

Permit Holder(s)/Owner(s) Name:

24-hour Emergency Contact:

Permit No:

Name of Regulatory Authority/Agency:

Agency Phone:

Agency Mailing Address:

Same as Commissary: Off

Operating Location 1:

Operating Location 2:

Operating Location 3:

City 3:

City 4:

City 5:

Date 1:

Date 2:

Date 3:

Hours of Operation 1:

Hours of Operation 2:

Hours of Operation 3:

Foods Served 1:

Foods Served 2:

Foods Served 3:

Foods Served 4:

Type 1:

Type 2:

Type 3:

Type 4:

Type 5:

Type 6:

Type 7:

Type 8:

Type 9:

Type 10:

Manufacturer 1:

Manufacturer 2:

Manufacturer 3:

Manufacturer 4:

Manufacturer 5:

Manufacturer 6:

Manufacturer 7:

Manufacturer 8:

Manufacturer 9:

Manufacturer 10:

Model Number 1:

Model Number 2:

Model Number 3:

Model Number 4:

Model Number 5:

Model Number 6:

Model Number 7:

Model Number 8:

Model Number 9:

Model Number 10:

Quantity 1:

Quantity 2:

Quantity 3:

Quantity 4:

Quantity 5:

Quantity 6:

Quantity 7:

Quantity 8:

Quantity 9:

Quantity 10:

Mobile Food Unit or Truck: Off

Mobile Food Pushcart: Off

Name:

Submittal Date:

Comments:

SCDA Representative:

Date 4:

Authorized/Not Authorized: Off

File details come from the government source that posted it. Updated Aug 21, 2025.