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Name of organization/business: Goldenstir Address: 315 Driftwood dr, Lodi Ca 95240 Phone: (209-327-3053 3. List food to be sold or given to the public: Almond Butter- 4 flavors including: "Classic Maple" "Simply Chocolate""Going ape Banana"and"Perfectly Plain" 4. 1 am providing food that is NOT prepared at home: Yes No X All food is prepared CYes❑ No on-site or is from Phone:( ) approved commercial facilities: Name of facility: We have the cottage food permit Address of facility: 315 Driftwood dr, Lodi Ca 95240 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) XEJ A 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 cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ❑ Approved bottled water. ❑ On-site hose bib that is connected to a potable water source. ❑ Other (specify): Handwashing station, including antibacterial soap, paper towels, and properly temped water 7. Electricity is provided for my booth's use E'es No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: IYes NU 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: N/A ❑ Camp stove ❑ Sterno&hotel trays ❑ ❑ ❑ Double steamer ❑ Steam table&lids Electric stove top Other(specify) Note: Examples of potentially hazardous food include: meats,tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products.