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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 />U3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />9 j.f.o-.Si,?-. ’ F <br />7. <br />8. <br />water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />Stock-en, C 3 9520; <br />Page 7 ot 11 <br />-C- ' 3 5 • sjgcv <br />TEMP EVENT APP <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Approyi <br />EHO 16-02 <br />06/29/2023 <br />Ln 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />required to return a signed and completed copy of this checklist to <br />'SUHOVS <br />Date(s): <br />All food vendors (both for profit and non-profit) are r , J. ' <br />the festival coordinator three (3) weeks prior to this event <br />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: 2*7 <br />Phone: (S| 0 ) sT. - 1 1 <br />List food to be sold or given to the public: s <br />Alternate: ( )_ <br />') I <br />I am providing food that is NOT prepared at home: H'Yes No <br />All food is prepared on-site or is frayi approved ^commercial facilities: <br />Name of facility: L> H~ /< <br />Address of facility: ? S I 5 T, <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):__________________ <br />Electricity is provided for my booth’s use: Yes tzfNo ~ <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: 0Yes No <br />1 arW0V'd'n9 the lowing hot temperature control for the hot holding of all potentially hazardous foods above <br />0Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />------—-------------------------: o Yes No <br />P" r Phone: <br />/-luvivQQ vi lauuiiy.___f I C 7 m I tS v k. 6ZT.I V V_____ <br />I am providing a booth with the following: flo protect my unp^ckaged food and food-preparation areas from flie« <br />dust apd the public)
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