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Farmers' Market Coordinator Form (Web Form)

  1. Farmers' Market Coordinator Form
  2. Header Info
  3. Event Information
  4. Market Coordinator/Responsible Party (main contact)
  5. Market Coordinator/Responsible Party (alternate contact)
  6. General Information
  7. A complete list of all food and beverage vendors must be provided, which includes: Business Name, Permit # (if applicable), Owner Name, address, phone number, e-mail, and menu.
  8. Will an approved potable water source be provided onsite for vendors?*
  9. Will wastewater disposal services be provided onsite for vendors?*
  10. Will trash/refuse disposal services be provided onsite for vendors*
  11. Will an electricity source be provided onsite for vendors?*
  12. Will back-up refrigerated storage be provided onsite for vendors:*
  13. Will animals be present at the event (petting zoo, rodeo, etc.)?*
    Please be aware that a mobile food establishment shall not be located within 100 feet of any petting, riding or holding area for animals unless dust and runoff are controlled.
  14. Restroom facilities:*
    Temporary toilet facilities shall not be located within 25 feet of any mobile food establishment.
  15. Do you have a dust control plan?*
    Having a plan in place for inclement weather is encouraged. Food/beverages must be protected from dust/other contaminants at all times.
  16. I hereby certify that the above information is correct, agree to comply with the Maricopa County Environmental Health Code, agree to allow the regulatory authority access to the establishment as specified under 8-402.11 and to the records specified under 3-203.12 and 5-205.13 and Subparagraph 8-201.14(D)(6), and I fully understand that any deviation from the above without prior permission from the Maricopa County Environmental Services Department may nullify final approval. By checking the check box and typing your name you have digitally signed this application.
  17. I agree the application is true and correct.
  18. Disclaimer
    Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law. This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.
  19. Once our staff has reviewed your form you may receive a follow-up email/call to clarify details provided on this form.
  20. Leave This Blank:

  21. This field is not part of the form submission.