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TEMPO. <br />i.Saturdays May- Oct Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Other (specify): <br />Electricity is provided for my booth's use: Yes No7. <br />8 <br />vegetables, potato salad, eggs, and dairy products. <br />Page 7 o( 11) 16 02 <br />11/16 <br />r <br /> Camp stove <br />O Double steamer <br />0 Electric stove top <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />ETI Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <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 />Name of facility: <br />Address of facility: \2. <br />are required to <br />(3) weeks prior to this event. <br />Market on Maple <br />The following is information about my organization/business. <br />Name of oroanbatinn/h, Trailer Parkd Coffee <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0 Stemo & hotel trays <br />0 Steam table & lids <br />Other (specify) C - fvo <br />Note: Examples of potentially hazardous food include: <br />■ # <br />meats, tamales, cooked beans, nee, <br />oTEMP EVENT APFf-1 <br />.RYFOOOVEN0OR.SflppL|CnrtON <br />the festival coordinator three°(3) weeksorfeOo this St?10 re‘Urn a signed and completed copy of this checklist to <br />TName of Event: <br />organization/business: <br />Address: 5 < AsCK : <br /> <br /> <br /> List food to be sold or given to the public: t <br />I am providing food that is NOT prepared at home: Yes Q No <br />All food is prepared^on-site or is from approved commercial facilities: K) Yes No <br /> Phone: (7fR ) - <br />C/f^------------------------------------------------------- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />0 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 />^3 Other (specify): ___ <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.