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TEMPORARY FOOD VENDOR’S APPLICATION <br />MOUNTAIN HOUSE FARMERS MARKET1.1. Name of Event:Date(s) <br />2 <br />Address: <br />Phone Alternate () <br />3 List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify). <br />6. <br /> On-site hose bib that is connected to a potable water source <br /> Other (specify) <br />/ <br />8 <br />9. <br />TFMP EVENT APRPage 7 of 11FHD 16 02 <br />08/01/16 <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />[^Approved bottled water. <br />SZSterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />YEAR <br />ROUND <br />0 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 Io separate food and food preparation <br />areas from the public. <br />Electricity is provided for my booth’s use: Yes WNo <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist Io <br />the festival coordinator three (3) weeks prior to this event <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F. <br />(73^) 0^30 <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 Qmes No <br />I am providing food that is NOT prepared at home: O'es No <br />All food is prepared on-site or is from approved commercial facilities No <br />Name of facility STocpfo'0 6 Phone (Z.^) <br />Address of facility IIP AJ- $7. ^<2,^ <br />meats, tamales, cooked beans, rice, <br />The following is information about my organization/businoss <br />Name of organization/businoss: CC-C PttA <br />£T. APT <br />c.a^nXSCjO. CA