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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HAMMER
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3422
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1600 - Food Program
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PR0545157
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COMPLIANCE INFO
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Entry Properties
Last modified
4/3/2020 1:35:07 PM
Creation date
4/3/2020 1:33:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0545157
PE
4110
FACILITY_ID
FA0025685
FACILITY_NAME
DREAMSCAPE BROWS (VO, LINDA)
STREET_NUMBER
3422
Direction
W
STREET_NAME
HAMMER
STREET_TYPE
LN
City
STOCKTON
Zip
95219
CURRENT_STATUS
01
SITE_LOCATION
3422 W HAMMER LN UNIT J
P_LOCATION
01
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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Please provide all information requested; an incomplete application may delay approval <br /> ❑ FACILITY INFORMATIO <br /> Name of Facility: Gingerbugs <br /> Street Address: 2 W.oak St <br /> City: Lodi Zip Code: 95240 <br /> ❑ FORMER NAME OF FACILITY <br /> ❑ BUSINESS OWNER INFORMATION <br /> Business Owner Name: James& Kelli Powell <br /> Home Address: 1919 Crystalwood Lane Lodi Ca.95242 <br /> Mailing Address: 1919 Crystalwood Lane Lodi Ca. 95242 <br /> Telephone Number: 209-747-1198 <br /> WOROPERWbWNER INFORMATION <br /> Property Owner Name: Ed Atwood <br /> Home Address: <br /> Mailing Address: <br /> Telephone Number: 206-313-6612 <br /> CONT INFORMATION <br /> Name of General Contractor: JTM Construction <br /> Mailing Address: 11603 Eagle Bay Rd Acampo Ca.95220 <br /> Telephone Number: 209-200-2170 <br /> Contact Person on Site: Mike Navara <br /> Site Phone Number: 209-200-2170 <br /> Source of Facility Water Supply: City of Lodi <br /> Backflow Protection: <br /> System to be used for Liquid Waste Disposal (Sewage): City of Lodi <br /> Solid Waste Disposal to be provided: waste Managment <br /> Grease Interceptor: None Required <br /> 6.❑ Fo Ioly <br /> List food(s) to be served and/or provide menu: <br /> Hot & Cold Coffee /Hot & Cold Tea/ Hot Chocolate / Pizza /Breadsticks <br /> ❑ OPERATIONAL INFORMATION <br /> Anticipated Business Hours: Open: 8:30 am Close: 1:30pm <br /> Anticipated Number of Employees: 1 <br /> EHD 16-01 4 PLAN CHECK GUIDE <br /> 7/5/17 <br />
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