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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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k <br />UIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) <br />1. <br />2. <br />Phone:Alternate: () <br />3. <br />4. <br />5. <br />Other (specify): <br />those which sell beverages from <br />6. <br />i_a <br />9. <br />5 <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />!?■ .. <br />TEMP EVENT APP <br />rice, <br />205 j <‘119 ^63.3420 | <br />Page Tot 11 <br />-./'I <br />9 M Lc^ <br />List food to be sold or given to the public: <br />K/c I <br />meats, tamales, cooked beans, <br />"AH iBAQl <br />l> (A 1 1^-4*_______ <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />EHO 16-02 <br />06/29/2023 <br /> A 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 />areas fr rn Uie pubfc3^ Srn°Oth WO°d afe accePtable) and constructed to separate food and food preparation <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: Q Yes Q No <br />Name of facility: phone; ( ) <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />r—) are required to return a signed and completed copy of this checklist to <br />•he festival coordinator three (3) weeks prior to this event. c-. . . > <br />1. Name of Event: 6??^Date(s): <br />Q On-site hose bib that is connected to a potable water source. <br />EfOther (specify): A H fn 4 ,/ <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: O Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F“. <br /> Camp stove Stef no & hotel trays <br /> Double steamer Stepm table & lids <br /> Electric stove top CpSther (specify) J (• c <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Q 1 4-c <br />/VZjn /Jo ___35-^ ) <br />The following is information about my organization/business: <br />Name of organization/business: U < h 3- I fx 1 <br />Address: 4 M N-* Lo fciy-e \ if a <br />2 5 ST
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