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I1. <br />2. <br />Name of organization/business: <br />U5G •goggW LN Address: <br />Alternate: ( SI 'Z^Oe-io ) 4(3-8TnPhone: <br />List food to be sold or given to the public: '<5noMjiC^vl€-S3. <br />□fes4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />7. <br />8. <br />9. <br />Steam <br />Other (specify)Electric stove top <br />TEMP EVENT APRPage 5 of 9EHD 16-02 <br />7/14/15 <br />I am providing an accurate probe thermomet< <br />foods during all times of booth operation Ef <br />jr to measure the hot and cold holding of potentially hazardous <br />YesO No <br />$ <br />1. Name of Event:Date(s): 1 * v‘ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from approved <br />dispensers, or prepackaged foods from approved sources. <br />The following is information about my organization/business: <br />v\ow/>< 6<>odesS(Or)S <br />I am providing food that is NOT prepared at homeO <br />All food is prepared <br />on-site or is from <br />approved commercial <br />facilities: -------+ <br />Name of facility: <br />Address of facility: <br />N92 <br />0* Yes No <br />Phone: ()_ <br />On-site hose bib that is connected to a potable water source. <br />Sink AS ulJt 3 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Other (specify):-^^;^ <br />Electricity is provided for my booth's use^/es q No <br />Sterno & hotel trays <br />[—| table & lids <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 />[ElA 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 /> Camp stove <br />[—] Double steamer