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TEMPORARY FOOD VENDOR’S APPLICATION <br />MOUNTAIN HOUSE FARMERS MARKETI.Name of Event <br />2. <br />Address: 4- <br />Phone: <br />3. <br />4. <br />5. <br />■^] Other (specify): <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />06/01/16 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 />>to measure the hot and cold holding of potentially hazardous <br />'es No <br /> On-site hose bib that is connected to a potable water source. <br />[vfother (specify): 5^Cll <br />Electricity is provided for my booth’s use: Yes <br />I am providing an accurate probe thermomel <br />foods during all times of booth operation: E <br /> Stemo & hotel trays <br /> Steam table & lids <br />L<ff)ther (specify) <br />Date(s): YEAR <br />ROUND <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 /> 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 />areas from the public. <br />th!/?0? v®ndors (both [°r Profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. weawsi io <br />1. <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 />The following is information about my organization/business: <br />Name of organization/business: ft <br />qS33O______ <br />(d5l ) Alternate: ( ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: [jjYes No <br />All food is prepar^on-siteorXs from approved commercial facilities: {vfYes □ No <br />Name of facility: Phone: ( ) <br />Address of facility:___