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6 <br />1. Name of Event: 1. <br />The following is information about my organization/business:2. <br />Yg-1 - TipName of organization/business: <br />y.o- fco* •Address: <br />70U>7Alternate: ( zo^ Y(Zo4? )3cf5. q7<?7Phone: <br />3. <br />4. <br />1 <br />5>re ' <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 />On-site hose bib that is connected to a potable water source. <br />Other (specify):5/QAbn p /oo°1-ciZ- <br />Electricity is provided for my booth's use7.o <br />8. <br />9. <br />Double steamer :able & lids <br />C A" Bo£oC&3Electric stove top Other (specify) <br />TEMP EVENT APPPage 5 of 9 <br />Hoil<NlK5 <br />O/es <br />EHD 16-02 <br />7/14/15 <br />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 />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 /> Camp stove <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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />List food to be sold or given to the public: <br />T^'T.-p pofahjes T* ecS, <br />I am providing food that is NOT prepared at homeEZ] <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 />Sterno & hotel trays <br />Steam <br />/ Archos <br />No / <br />Ores No <br />Phone: ( <br />I am providing an accurate probe thermometpp-to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation [ZT YesEJ No <br />Date(s):