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I 1. 2. o Address: <5 3. 5. 6. Other (specify): use7. 8. 9. X|a table & lids TEMP EVENT APR Page 5 of 9 EHD 16-02 7/14/15 I am providing a booth with the foliowing: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) Phone: List food to be sold or given to the public: _lxt 4. | am providing food that is NOI prepared at homeD 0es All food is prepared on-site or is from approved commercial facilities: Name of facility: Address of facility: I am providing an accurate probe thermome) foods during all times of booth operation S-VonM^t- \?>qq SvAk< —U ;0 Other (specify): Note- The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided Sterno & hotel trays Steam Other (specify) Q Approved bottled water. On-site hose bib that is connected to a potable water source. Other (specify): J ------------------------------------ ----------------------- Electricity is provided for my booth s use^Yes J^No >r to measure the hot and cold holding of potentially hazardous YestZ) No control for the hot holding of all potentially hazardous foods above I am providing the following hot temperature 135°F: in my booth by the following methods: 1. Name of Event:Date(s).---------1 I The following is information about my organization/business: Tro ♦F Ga — Name of organization/business. ----id-S—---- ----- - J ^rtAl,ema,e:( No 13 Yes No Phone: (1 □ A twlb with »*• Will lei'.'.'/ areas from the public. Camp stove PI Double steamer Electric stove top