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se&EEwr 7)rgfl?- <?/■2&I1 ?iNaniK ui event. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />7. <br />meats, tamale*, cooked bean*, rice. <br />vegetables, potato salad, eggs, and dairy products. <br />TEMP EVENT APPP*go7o(H <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />EHD 18-02 <br />lonvN <br />'ty£L foFNeES <br />The following is information aooui my viyanizauon/business: <br />ya-a--'U»7srl <br />aTw, lorrT ar- - tp-a-cm, ca _______ <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 /> A booth with walls and celling 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 />ffl Other (specify): TOO QUyg, <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />Name of organlzatlon/business: __________________________ <br />^l^lp y'/rl CA ^1337 <br />) Alternate: ) A 2^8 <br />List food to be sold or given to the public: Ql3\/g~ OIL- _______ <br />I am providing food that Is NOT prepared at home: 1)9.Yes No <br />All food is prepared on-site or Is from approved commercial facilities: ® Yes No <br />Name of facility; z Phone; ( <br />Address of facility:. <br /> Approved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br />Other (specify): 3 trOR- ______ <br />ElecMrJty Is provided for my booth’s use; Yes^No <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 'U/Acr <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135*F: W/A <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food Include*.