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TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3)weeks prior to this event. 1. 1. Name of Event: The StockMarket Date(s): 11-19-16 2. The following is information about my organization/business: Name of organization/business: GoldenStir Almond Butter Address: 315 Driftwood Dr, Lodi ca 95240 Phone: ( 209 -327-3053 ) Alternate: ( ) 3. List food to be sold or given to the public: Maple Almond butter/Chocolate almond butter/Banana almond butter I am providing food ❑ Yes1K No that is NOT prepared at home: Yes ❑ Yes No No Phone: 1 All food is prepareun-site Name of facility: Cottage food permit approved kitchen. Permit number PT24874 Address of facility: 315 Driftwood dr, Lodi ca95240 4. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑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. X (other) Pop up tent. My prodcuts are sealed and remain sealed until customer purchases and opens at their disc Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water-X ❑ On-site hose bib that is connected to a potable water source. ❑ Other(specify): 6. Electricity is provided for my booth's use: Yes X No EHD 16-02 Page 1 of 7 TEMP EVENT APP 7/14/15