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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0542072
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
1/16/2026 11:44:05 AM
Creation date
1/16/2026 11:40:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0542072
PE
1682 - CERTIFIED FARMERS MARKET SITE
FACILITY_ID
FA0024162
FACILITY_NAME
MOUNTAIN HOUSE CERT FARMERS MRKT
STREET_NUMBER
251
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\ymoreno
Supplemental fields
Site Address
251 E MAIN ST MOUNTAIN HOUSE 95391
Tags
EHD - Public
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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone:Alternate: (<=06. <br />3. <br />4. <br />1 <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />the hot and cold holding of potentially hazardous <br />9.itrol for the hot holding of alt potentially hazardous foods above <br />meats, tamales, cooked beans, rice, <br />9 <br />TEMP EVENT APP <br />Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />r> <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Apprp<ed water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />C Approved bottled water. <br />Name of organization/business: <br />P a <br />EHD 1602 <br />061-29/2023 <br /> On-site hose bib that is connected to a potable water source. <br />0 Other (specify):_______________________________ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />I am oroviding the following hot temperature <br />JSST: <br />•C Camp stove <br /> Double steamer <br />0 Electric stove top <br />The following is information about my organization/business: <br />R ' S p. h \ <br />0A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Fei -J (_______ <br />/ S <br />)___________ <br />am providing food that is NOT prepared at home: Eu Yes 0 No <br />"2 All food is prepared on-site or is from approved commercial facilities(f0>^s 0 No <br />• Name of facility: _________________________Thono: (___ <br />Address of facility: \ \- p( 5 5 ) <br />I am providing a booth with the following: (to protect rtiy unpackaged food and food-preparation areas from flie* <br />dust and the public) <br />•3420 : <br />Page 7 of 11 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />‘.he festival coordinator three (3) weeks prior to this event <br />1. Name of Event: Date{s); <br />Address: <br />- 7^ <br />List food to be sold or given to the public:
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