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\ <br />K 1. <br />2. <br />XUAddress: <br />Phone: <br />List food to be sold or given to the public: 3. <br />5. <br /> Other (specify): <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />Other (specify): <br />Electricity is provided for my booth’s useQ Yes No7. <br />8. <br />9. <br />table & lids <br />Electric stove top Other (specify) <br />Page 5 of 9 TEMP EVENT APPEHD 16-02 <br />7/14/15 <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 />». i / | <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 />S^A 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 an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation Yes^No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />4. I am providing food that is NOT prepared at homeD/JO^^es <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 />1. Name of .Event i_/ate(s): <br />Ci/cwt! vci[(wz svpzt-' c&jt S'hotx) <br />The following is information about my organization/business: <br />Name of organization/business: <br /><<) Alternate: ( ). <br />corns <br />JS^Yes Q No <br />Phone: () <br />Sterno & hotel trays <br />Steam [—] <br /> Camp stove <br />[—| Double steamer <br />On-site hose bib that is connected to a potable water source.