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Address: Phone. 3 4 5 Other (specify). 6 On-site hose bib that is connected to a potable water source Other (specify): 7 8 9 moats, tamalos. cooked boans. rico. TEMP EVENT APPPage 7 o'11EHD16O2 7/14.15 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources Camp stove Double steamer H Electric stove top Stemo & hotel trays Steam table & lids toother (speafy) Electricity is provided for my booth s use Yes No Noto: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135’F: Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods jC Approved bottled water I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods dunng all times of booth operation Yes No I am providing food that is NOT prepared at home Yes No All food is prepared on-site or is from approved commercial facilities J? Yes No - Name of facility .Phone Address of facility I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, dust and the public) booth with walls and ceiling constructed of either wood, canvas plastic, similar material and fine mesh fly screening, completely enclosing open food areas It will also have a smooth and deanabie floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. t bTocK-fon ,1^______________________ ) Xy? Xi0!0) Alternate. ( ) List food to be sold or given to the public