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3 <br />i. <br />2 <br />PhOK <br />1 <br />svNOT pj* <br />4 <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 />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11'□16-02 <br />15 <br /> Camp stove <br />[^Double steamer <br /> Electric stove top <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 am providing an accurate probe thermom< <br />foods during all times of booth operation: C <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 /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> 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 />HOther (specify): » <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />TEMPORARY FOOD VENDOR’S APPUCATION <br />AB tad vearibK for pnS and ncn-profi) are required to return a signed and completed copy of this checklist to <br />Be irtadlcnndNataraeee weeks prior to this event <br /> tJteecdI• Date(s): (p/ /y <br />TheMhaw** ■doBNafeoR about my organization/business: 7 <br /> Ca^Kiry]. <br />( 333* l! Alternate: (2o^\ ''7L£7• <br />lad tad Id be sdd or given to the public: I'j^^ <br />I am pKMdtog food that ts^NOT wtepared at home: Yes No <br />AB food is prepared on-site-erlsfrom approved commercial facilities: [vfYes No . <br />Mane of tacfity: ff) I CpS Phone: <br />Address of fadfitv: | ^>0 | 5. J M <br /> On-site hose bib that is connected to a potable water source. <br />G/J Other (specify): ''pQdd \ <br />Electricity is provided for my booth’s use: (ZfYes No <br />nefor to measure the hot and cold holding of potentially hazardous <br />0 Yes No