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11: 2. Address: Phone: 3. 4. 1 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. Electricity is provided for my booth’s use^Yes No7. 8. 9. Sterno & SteamDouble steamer Other (specify)Electric stove top TEMP EVENT APRPage 5 of 9 No Q Yes No Phone: (___ EHD 16-02 7/14/15 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) I am providing an accurate probe thermometi foods during all times of booth operation M jYto measure the hot and cold holding of potentially hazardous Yesd No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: 1. Name of Event:L Camp stove I am providing food that is NOT prepared at homeO All food is prepared on-site or is from approved commercial facilities: Name of facility: Address of facility: booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. On-site hose bib that is connected to a potable water source. ^^Other (specify): The following is information about my organization/business: Name of organization/business: <'3-iAl,erna,e: List food to be sold or given to the public: hotel trays |—| table & lids