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-fir <br /> ,eflIPORAR. . FOLD[,` V <br /> y; ,IjtiOn ,1bU'Jo.' <br /> �5. . <br /> tYti1 <br /> 2. `r fie '- - ---- - - - <br /> Name of or(jan:za�onibusiness: <br /> Address'- ernate: <br /> PhOnC,: <br /> � iven to the publics <br /> 3. List food to be sold or 9 <br /> 10 <br /> am providing food that Is NOT prepared at hornet � Yes ❑ l` <br /> cor rn �rcil fa ice= � Yes E] No p 2_2 , <br /> #+food is prepared on-site or is�frorn approved phone. — ` = , <br /> -� ` ' --- <br /> Name cf facility: _ -=� 1 �, { %r ! d '% ----_ --- --- <br /> Address of favi€i y:_^_ —. `g <br /> ,;. l m providing a�iootn with <br /> the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> TI <br /> booth with wa re aration <br /> fetal enclosing open food areas. it will also StrLicteti totpepa separate food <br /> asphalt. <br /> pfloor (cpr�crete, <br /> asphalt. clean <br /> comp y <br /> asohalt. clean tarps and smooth wood are acceptable) and co <br /> areas from, the public. ' , --- <br /> A, <br /> EOther (.specify): __ <br /> ;rations not required to provide enclosed booths are those which sell beverages from <br /> Note: The only ops prepackaged foods from approvcd sources. <br /> apf;roved disprns^�. ae <br /> , • <in , utensil and hand tiy'ashing will be p <br /> .�� rovided in my booth by the fallowing methods. <br /> .�arovedster for drinl g- <br /> ,. ed bottled water. <br /> i41 <br /> _ ,,, ♦ E. rh that is connected to a potable water source. t p <br /> _ <br /> for rl <br /> y booth's Use' [_1 Yes No <br /> riOCi r <br /> "_aid( <br /> thermometer to measure the hot and cold holding of potentially <br /> -f, an acctirate rrobe <br /> f_c.,,jrj.; rfiiring all doles Of b?octh Ol_)EraLi0n: yeS <br /> No <br /> � control for the hot holding of all potentially hazardotirs foods at <br /> ,,1r, follov�in,j <br /> Sterno & Hotel trays <br /> - ❑ Steam aisle lids _. <br />